Provider Demographics
NPI:1063065951
Name:ENO, COLINS OGWANDI
Entity type:Individual
Prefix:DR
First Name:COLINS
Middle Name:OGWANDI
Last Name:ENO
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 1:2655 FRAYSER BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-4832
Mailing Address - Country:US
Mailing Address - Phone:901-353-0639
Mailing Address - Fax:
Practice Address - Street 1:2655 FRAYSER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-4832
Practice Address - Country:US
Practice Address - Phone:901-353-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist