Provider Demographics
NPI:1972257269
Name:NDIKUM, CHANTALE NGUM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHANTALE
Middle Name:NGUM
Last Name:NDIKUM
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 1:13526 GAINESWAY DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5194
Mailing Address - Country:US
Mailing Address - Phone:713-922-7147
Mailing Address - Fax:
Practice Address - Street 1:3000 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3121
Practice Address - Country:US
Practice Address - Phone:979-822-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist