Provider Demographics
NPI:1851904064
Name:MBACHU, GINA CHIAMAKA (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:CHIAMAKA
Last Name:MBACHU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1814
Mailing Address - Country:US
Mailing Address - Phone:651-414-3882
Mailing Address - Fax:
Practice Address - Street 1:2099 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1814
Practice Address - Country:US
Practice Address - Phone:651-414-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist