Provider Demographics
NPI:1104974211
Name:EZEANII, CHRIS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:EZEANII
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 1:525 FRANKLIN GTWY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7707
Mailing Address - Country:US
Mailing Address - Phone:678-581-1223
Mailing Address - Fax:678-581-2356
Practice Address - Street 1:525 FRANKLIN GTWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7707
Practice Address - Country:US
Practice Address - Phone:678-581-1223
Practice Address - Fax:678-581-2356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist