Provider Demographics
NPI:1659745883
Name:OKEMUO, CHIOMA
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:
Last Name:OKEMUO
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 1:3605 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4617
Mailing Address - Country:US
Mailing Address - Phone:409-832-7374
Mailing Address - Fax:409-832-7863
Practice Address - Street 1:3605 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4617
Practice Address - Country:US
Practice Address - Phone:409-832-7374
Practice Address - Fax:409-832-7863
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist