Provider Demographics
NPI:1982185104
Name:UDEMGBA, CHIKODILI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHIKODILI
Middle Name:
Last Name:UDEMGBA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-1703
Mailing Address - Country:US
Mailing Address - Phone:601-334-6090
Mailing Address - Fax:
Practice Address - Street 1:719 BROOKWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2639
Practice Address - Country:US
Practice Address - Phone:601-833-8509
Practice Address - Fax:601-833-9626
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist