Provider Demographics
NPI:1780852566
Name:MADU, CHINWE UKACHI (PHARMD, MSW)
Entity Type:Individual
Prefix:
First Name:CHINWE
Middle Name:UKACHI
Last Name:MADU
Suffix:
Gender:F
Credentials:PHARMD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17715 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7418
Mailing Address - Country:US
Mailing Address - Phone:562-298-6702
Mailing Address - Fax:
Practice Address - Street 1:17715 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-7418
Practice Address - Country:US
Practice Address - Phone:562-298-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23320104100000X
ORRPH-0017579183500000X, 1835P0018X
CARPH-85522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist