Provider Demographics
NPI:1770181596
Name:AIGBERADION, CHARLES IHONRE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:IHONRE
Last Name:AIGBERADION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 BARCLAY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-6080
Mailing Address - Country:US
Mailing Address - Phone:832-875-2246
Mailing Address - Fax:832-604-7933
Practice Address - Street 1:13211 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4439
Practice Address - Country:US
Practice Address - Phone:832-604-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist