Provider Demographics
NPI:1487274056
Name:AJAERO, NNEAMAKA (PHARMD)
Entity type:Individual
Prefix:
First Name:NNEAMAKA
Middle Name:
Last Name:AJAERO
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 1:24919 CLEARWATER WILLOW TRCE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3201
Mailing Address - Country:US
Mailing Address - Phone:646-203-7708
Mailing Address - Fax:
Practice Address - Street 1:4746 TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-3038
Practice Address - Country:US
Practice Address - Phone:409-960-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61305OtherTEXAS STATE BOARD OF PHARMACY LICENSE