MEDICARE: CHINYERE IJEOMA NDUKUBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	E-09999	MS

General Provider Information

NPI Number	:	1366697351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINYERE IJEOMA NDUKUBA

Provider Business Mailing Address
First Line	:	37 LAWRENCE PL
Second Line	:
City	:	CHESTNUT RIDGE
State	:	NY
Zip	:	10977-6414
Country	:	US
Telephone Number	:	601-405-1709
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 ROUTE 17 N
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1167
Country	:	US
Telephone Number	:	201-327-0411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	08/07/2010

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Directions to “ CHINYERE IJEOMA NDUKUBA ” Practice Location

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