Provider Demographics
NPI:1356056535
Name:KEKE, CHUKWUDIEBERE
Entity type:Individual
Prefix:
First Name:CHUKWUDIEBERE
Middle Name:
Last Name:KEKE
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 1:6214 ALLENDALE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1048
Mailing Address - Country:US
Mailing Address - Phone:713-922-4351
Mailing Address - Fax:
Practice Address - Street 1:22125 CUMBERLAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6494
Practice Address - Country:US
Practice Address - Phone:281-758-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist