Provider Demographics
NPI:1699428201
Name:CHUKWUKELU, UDECHUKWUNYERE A
Entity type:Individual
Prefix:
First Name:UDECHUKWUNYERE
Middle Name:A
Last Name:CHUKWUKELU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 MCDANIEL STREET
Mailing Address - Street 2:1A
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030
Mailing Address - Country:US
Mailing Address - Phone:702-477-0311
Mailing Address - Fax:702-477-0316
Practice Address - Street 1:2290 MCDANIEL ST
Practice Address - Street 2:1A
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:170-247-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist