Provider Demographics
NPI:1356928055
Name:EZEKWEM, KELECHI D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELECHI
Middle Name:D
Last Name:EZEKWEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S VOSS RD APT 323
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2646
Mailing Address - Country:US
Mailing Address - Phone:832-287-2085
Mailing Address - Fax:
Practice Address - Street 1:1102 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-5302
Practice Address - Country:US
Practice Address - Phone:281-471-7282
Practice Address - Fax:281-471-1361
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist