Provider Demographics
NPI:1487095881
Name:CHIAKU, SYLVANUS C
Entity type:Individual
Prefix:
First Name:SYLVANUS
Middle Name:C
Last Name:CHIAKU
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 1:8735 VERDE LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3408
Mailing Address - Country:US
Mailing Address - Phone:941-914-8008
Mailing Address - Fax:
Practice Address - Street 1:8735 VERDE LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3408
Practice Address - Country:US
Practice Address - Phone:941-914-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41005183500000X
FLPU 69381835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support