Provider Demographics
NPI:1144935826
Name:IFEDI, CHIDI OGOCHUKWU (RPH)
Entity type:Individual
Prefix:
First Name:CHIDI
Middle Name:OGOCHUKWU
Last Name:IFEDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 ROBERTS CREST DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6582
Mailing Address - Country:US
Mailing Address - Phone:678-687-3283
Mailing Address - Fax:
Practice Address - Street 1:4003 ROBERTS CREST DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6582
Practice Address - Country:US
Practice Address - Phone:678-687-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist