Provider Demographics
NPI:1912501461
Name:NONYELUM, KENNETH CHIJIOKE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHIJIOKE
Last Name:NONYELUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12336 GREAT COMMISSION WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7110
Mailing Address - Country:US
Mailing Address - Phone:321-945-4461
Mailing Address - Fax:
Practice Address - Street 1:4315 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2706
Practice Address - Country:US
Practice Address - Phone:407-896-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist