MEDICARE: DR. CALISTA IJEOMA CHUKWU PHARMACIST, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	175399	NC
2	183500000X	Pharmacist	18613	NC

General Provider Information

NPI Number	:	1790935930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALISTA IJEOMA CHUKWU PHARMACIST, RN

Provider Business Mailing Address
First Line	:	251 AVOCET LN
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-6575
Country	:	US
Telephone Number	:	919-398-4693
Fax Number	:

Provider Business Practice Location Address
First Line	:	9641 BITTER MELON DR
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-5917
Country	:	US
Telephone Number	:	919-639-6030
Fax Number	:	919-639-6036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	02/04/2021

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