Provider Demographics
NPI:1659641157
Name:JIWUAKU, CHIAWUOTU ONYEOZIRILE
Entity type:Individual
Prefix:DR
First Name:CHIAWUOTU
Middle Name:ONYEOZIRILE
Last Name:JIWUAKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHIAWUOTU
Other - Middle Name:ONYEOZIRILE
Other - Last Name:NWOSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2823 KAITLIN WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0420
Mailing Address - Country:US
Mailing Address - Phone:713-480-6216
Mailing Address - Fax:
Practice Address - Street 1:2823 KAITLIN WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0420
Practice Address - Country:US
Practice Address - Phone:713-480-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist