Provider Demographics
NPI:1366697351
Name:NDUKUBA, CHINYERE IJEOMA
Entity type:Individual
Prefix:
First Name:CHINYERE
Middle Name:IJEOMA
Last Name:NDUKUBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LAWRENCE PL
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6414
Mailing Address - Country:US
Mailing Address - Phone:601-405-1709
Mailing Address - Fax:
Practice Address - Street 1:1300 ROUTE 17 N
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1167
Practice Address - Country:US
Practice Address - Phone:201-327-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist