Provider Demographics
NPI:1740964808
Name:AMADI, CHINENYE GLADYS
Entity type:Individual
Prefix:
First Name:CHINENYE
Middle Name:GLADYS
Last Name:AMADI
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 1:5631 DYER ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-6204
Mailing Address - Country:US
Mailing Address - Phone:915-245-3517
Mailing Address - Fax:915-245-3517
Practice Address - Street 1:5631 DYER ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-6204
Practice Address - Country:US
Practice Address - Phone:915-425-3517
Practice Address - Fax:915-245-3517
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist