Provider Demographics
NPI:1790015055
Name:NNOROM, CHIDI
Entity Type:Individual
Prefix:MRS
First Name:CHIDI
Middle Name:
Last Name:NNOROM
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 1:4710 E ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4264
Mailing Address - Country:US
Mailing Address - Phone:480-214-0969
Mailing Address - Fax:480-214-0972
Practice Address - Street 1:4710 E ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4264
Practice Address - Country:US
Practice Address - Phone:480-214-0969
Practice Address - Fax:480-214-0972
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist