Provider Demographics
NPI:1609472281
Name:ABAZIE, CORDELIA NGOZI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CORDELIA
Middle Name:NGOZI
Last Name:ABAZIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3818
Mailing Address - Country:US
Mailing Address - Phone:832-657-5529
Mailing Address - Fax:
Practice Address - Street 1:4100 W AIRPORT FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5913
Practice Address - Country:US
Practice Address - Phone:972-313-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX460163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX46016OtherPHARMACIST LICENSE