Healthcare Provider Details

I. General information

NPI: 1487020525
Provider Name (Legal Business Name): CHIEMEZIE OTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 SCHAEFFER DR
EADS TN
38028-4000
US

IV. Provider business mailing address

2846 SCHAEFFER DR
EADS TN
38028-4000
US

V. Phone/Fax

Practice location:
  • Phone: 901-335-6227
  • Fax:
Mailing address:
  • Phone: 901-335-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10637
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: