Basic Information
| Provider Information | |||||||||
| NPI: | 1003014390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UMEANO | ||||||||
| FirstName: | CHINYELU | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 484 GRANITE PT | ||||||||
| Address2: | |||||||||
| City: | MARTINEZ | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309075129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062284874 | ||||||||
| FaxNumber: | 7062287227 | ||||||||
| Practice Location | |||||||||
| Address1: | 484 GRANITE PT | ||||||||
| Address2: | |||||||||
| City: | MARTINEZ | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309075129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062284874 | ||||||||
| FaxNumber: | 7062287227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH019439 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.