Provider Demographics
NPI:1255978011
Name:IKEOGU, CHIJIOKE
Entity type:Individual
Prefix:
First Name:CHIJIOKE
Middle Name:
Last Name:IKEOGU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-9559
Mailing Address - Country:US
Mailing Address - Phone:734-439-6856
Mailing Address - Fax:
Practice Address - Street 1:531 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-9559
Practice Address - Country:US
Practice Address - Phone:734-439-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-28
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020382491835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist