Healthcare Provider Details

I. General information

NPI: 1699455030
Provider Name (Legal Business Name): CECIL EKECHUKWU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/23/2023
Certification Date: 07/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S VALLEY DR
LAS CRUCES NM
88005-3110
US

IV. Provider business mailing address

2013 SHREYA ST
EL PASO TX
79938-4662
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-6844
  • Fax:
Mailing address:
  • Phone: 216-543-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009924
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: