Chizoba Odimgbe
Individual provider Active NPI Pharmacist · Port Wentworth, GA
NPI 1477182012 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1477182012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH030626 (GA)
- Practice address
- 18 Raintree Way
Port Wentworth, GA 31407-3605 - Phone
- (912) 237-1681
- NPI assigned
- Apr 6, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH030626 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH030626 | GA | Yes |
Addresses
Primary practice location
18 Raintree Way
Port Wentworth, GA 31407-3605
Mailing address
18 Raintree Way
Port Wentworth, GA 31407-3605
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH030626 | Other | GA | GEORGIA BOARD OF PHARMACY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Walgreens.com | WALGREEN CO |
Other providers in Port Wentworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.