Provider Demographics
NPI:1881840577
Name:ILOANYA, CHIMEZIE
Entity Type:Individual
Prefix:
First Name:CHIMEZIE
Middle Name:
Last Name:ILOANYA
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 1:6776 SOUTHWEST FWY
Mailing Address - Street 2:STE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2107
Mailing Address - Country:US
Mailing Address - Phone:713-782-0558
Mailing Address - Fax:713-782-0508
Practice Address - Street 1:6776 SOUTHWEST FWY
Practice Address - Street 2:STE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2107
Practice Address - Country:US
Practice Address - Phone:713-782-0558
Practice Address - Fax:713-782-0508
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145421Medicaid
5328470001Medicare NSC