Provider Demographics
NPI:1942579883
Name:ANYAMELE, OCHEZE
Entity Type:Individual
Prefix:DR
First Name:OCHEZE
Middle Name:
Last Name:ANYAMELE
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 1:3835 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5232
Mailing Address - Country:US
Mailing Address - Phone:601-362-6409
Mailing Address - Fax:601-362-9363
Practice Address - Street 1:3835 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5232
Practice Address - Country:US
Practice Address - Phone:601-362-6409
Practice Address - Fax:601-362-9363
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010038183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist