Provider Demographics
NPI:1538877600
Name:EZE, CHIEDOZIE C (RPH)
Entity type:Individual
Prefix:
First Name:CHIEDOZIE
Middle Name:C
Last Name:EZE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 COUNTRY CLUB DR SE APT 1F
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5826
Mailing Address - Country:US
Mailing Address - Phone:770-572-3443
Mailing Address - Fax:
Practice Address - Street 1:839 COUNTRY CLUB DR SE APT 1F
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5826
Practice Address - Country:US
Practice Address - Phone:770-572-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist