Provider Demographics
NPI:1992321277
Name:EZEUDU, CHINONSO BRIGHT
Entity type:Individual
Prefix:
First Name:CHINONSO
Middle Name:BRIGHT
Last Name:EZEUDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13818 ROSEMERE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-1200
Mailing Address - Country:US
Mailing Address - Phone:832-525-5861
Mailing Address - Fax:
Practice Address - Street 1:12647 ASHFORD MEADOW DR APT A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6252
Practice Address - Country:US
Practice Address - Phone:883-525-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX573601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist