Healthcare Provider Details

I. General information

NPI: 1497138275
Provider Name (Legal Business Name): DR. KELA DELPHINE NJIKE TAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. DELPHINE KELA NJIKE

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 MORGANTON RD
FAYETTEVILLE NC
28303-4963
US

IV. Provider business mailing address

611 BEAUHAVEN LN
WAXHAW NC
28173-7451
US

V. Phone/Fax

Practice location:
  • Phone: 910-868-5103
  • Fax:
Mailing address:
  • Phone: 617-877-1429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: