Healthcare Provider Details

I. General information

NPI: 1639454788
Provider Name (Legal Business Name): CHIAJU UKEGBU PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOLENSVILLE PIKE
BRENTWOOD TN
37027-8800
US

IV. Provider business mailing address

PO BOX 1672
ANTIOCH TN
37011-1672
US

V. Phone/Fax

Practice location:
  • Phone: 615-941-7239
  • Fax: 615-941-7240
Mailing address:
  • Phone: 615-364-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000033343
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: