Individual provider Active NPI

Chidinma Jenny Chikezie, PHARMD

  • Pharmacist
  • Carson, CA
National Provider Identifier
1578832259
Registry record updated Dec 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
61812 Issued in CA
Practice address
22005 Avalon Blvd Ste D
Carson, CA 90745-7169
Phone
(310) 422-6586
Fax
(310) 422-6586
NPI assigned
Dec 23, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 61812 CA Primary

Addresses

Primary practice location

22005 Avalon Blvd Ste D
Carson, CA 90745-7169

Mailing address

20111 Wadley Ave
Carson, CA 90746-3046
Phone (310) 422-6586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
61812CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Carson Wellness Pharmacy Inc Current Accepting new patients

Locations

22005 Avalon Blvd
Ste D
Carson, CA 90745
Phone (310) 422-6586

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514678400000",
    "number": "1578832259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20111 WADLEY AVE",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463046",
            "telephone_number": "310-422-6586",
            "fax_number": "424-295-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22005 AVALON BLVD STE D",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907457169",
            "telephone_number": "310-422-6586",
            "fax_number": "310-422-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHIKEZIE",
        "first_name": "CHIDINMA",
        "middle_name": "JENNY",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-23",
        "last_updated": "2017-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "61812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.