Healthcare Provider Details

I. General information

NPI: 1144057480
Provider Name (Legal Business Name): PRECIOUS NDIDI NKEM EHIODO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRECIOUS NDIDI NKEM OBINNA PHARMD

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

156 KALINA ST
FORT POLK LA
71459-3562
US

V. Phone/Fax

Practice location:
  • Phone: 726-780-2019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202222299
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: