Healthcare Provider Details

I. General information

NPI: 1356056535
Provider Name (Legal Business Name): CHUKWUDIEBERE KEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22125 CUMBERLAND RIDGE DR
CYPRESS TX
77433-6494
US

IV. Provider business mailing address

6214 ALLENDALE RIDGE TRL
RICHMOND TX
77407-1048
US

V. Phone/Fax

Practice location:
  • Phone: 281-758-1031
  • Fax:
Mailing address:
  • Phone: 713-922-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: