Provider Demographics
NPI:1588469969
Name:NWACHUKWU, EZINNE
Entity type:Individual
Prefix:
First Name:EZINNE
Middle Name:
Last Name:NWACHUKWU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 LAGUNA SHORES DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6749
Mailing Address - Country:US
Mailing Address - Phone:346-237-0473
Mailing Address - Fax:
Practice Address - Street 1:5753 N CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2206
Practice Address - Country:US
Practice Address - Phone:773-631-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist