Provider Demographics
NPI:1013630987
Name:CHICHISO, HENOK
Entity Type:Individual
Prefix:
First Name:HENOK
Middle Name:
Last Name:CHICHISO
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 1:2525 S VOSS RD APT 434
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4438
Mailing Address - Country:US
Mailing Address - Phone:281-905-0746
Mailing Address - Fax:
Practice Address - Street 1:485 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-4221
Practice Address - Country:US
Practice Address - Phone:409-697-3211
Practice Address - Fax:409-697-3440
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist