Provider Demographics
NPI:1134728355
Name:DAMIAN, ADAEZE IFUNANYA
Entity type:Individual
Prefix:DR
First Name:ADAEZE
Middle Name:IFUNANYA
Last Name:DAMIAN
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 1:27914 HAWKEYE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7432
Mailing Address - Country:US
Mailing Address - Phone:773-507-3127
Mailing Address - Fax:
Practice Address - Street 1:9919 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3802
Practice Address - Country:US
Practice Address - Phone:713-532-5858
Practice Address - Fax:713-532-9634
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX592831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist