Provider Demographics
NPI:1790935930
Name:CHUKWU, CALISTA IJEOMA (PHARMACIST, RN)
Entity Type:Individual
Prefix:DR
First Name:CALISTA
Middle Name:IJEOMA
Last Name:CHUKWU
Suffix:
Gender:F
Credentials:PHARMACIST, RN
Other - Prefix:DR
Other - First Name:CALISTA
Other - Middle Name:IJEOMA
Other - Last Name:NWOMEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM-D
Mailing Address - Street 1:251 AVOCET LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-6575
Mailing Address - Country:US
Mailing Address - Phone:919-398-4693
Mailing Address - Fax:
Practice Address - Street 1:9641 BITTER MELON DR
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5917
Practice Address - Country:US
Practice Address - Phone:919-639-6030
Practice Address - Fax:919-639-6036
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175399163W00000X
NC18613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse