Provider Demographics
NPI:1629515762
Name:MADUEKWE, CHIDINMA
Entity Type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:
Last Name:MADUEKWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2807
Mailing Address - Country:US
Mailing Address - Phone:845-792-3006
Mailing Address - Fax:
Practice Address - Street 1:81 ROUTE 303
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2807
Practice Address - Country:US
Practice Address - Phone:845-792-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist