Provider Demographics
NPI:1386048452
Name:NALLS-AHAIWE, CHINYE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHINYE
Middle Name:
Last Name:NALLS-AHAIWE
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 1:5165 WALNUT AVE
Mailing Address - Street 2:#18
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5801
Mailing Address - Country:US
Mailing Address - Phone:281-796-1162
Mailing Address - Fax:
Practice Address - Street 1:27320 W LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2041
Practice Address - Country:US
Practice Address - Phone:909-307-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist