Healthcare Provider Details

I. General information

NPI: 1043463706
Provider Name (Legal Business Name): CHUKWUEMEKA FRANK S OBIDIKE PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 01/04/2021
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S WEST ST
ALEXANDRIA VA
22314-2824
US

IV. Provider business mailing address

CVS/PHARMACY STORE #16863 GROVETON 6600 RICHMOND HWY
ALEXANDRIA VA
22306
US

V. Phone/Fax

Practice location:
  • Phone: 240-421-1909
  • Fax:
Mailing address:
  • Phone: 703-253-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051290866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: