Provider Demographics
NPI:1356984744
Name:KAMMELU, CHINEDUM O (PHARMD)
Entity type:Individual
Prefix:
First Name:CHINEDUM
Middle Name:O
Last Name:KAMMELU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CANAL ST APT 910
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1519
Mailing Address - Country:US
Mailing Address - Phone:774-701-2540
Mailing Address - Fax:
Practice Address - Street 1:354 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3936
Practice Address - Country:US
Practice Address - Phone:603-352-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY00937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30Medicaid