Charles Ebiliekwe, PHARMD
Individual provider
Active NPI
Pharmacist · San Juan, TX
NPI 1851994198 · NPPES record last updated Nov 19, 2020
Key facts
- NPI
- 1851994198
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 53910 (TX)
- Practice address
- 100 E FM 495
San Juan, TX 78589-3710
- Phone
- (956) 283-7880
- NPI assigned
- Nov 19, 2020
- Sex
- Male
- Sole proprietor
- No
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.
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|
| 53910 | TX | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|
| CVS Pharmacy Inc |
|
Past
since Nov 22, 2020 |
Accepting new patients |
Interoperability endpoints
- Direct secure messaging: charles.ebiliekwe@cvshealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Pharmacist |
183500000X |
53910 |
TX |
Yes |
Addresses
Primary practice location
100 E FM 495
San Juan, TX 78589-3710
Mailing address
810 S Taylor Rd Apt 927
Mission, TX 78572-0227
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 53910 | Other | TX | TEXAS STATE BOARD OF PHARMACY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|
| Direct Messaging Address |
Charles.ebiliekwe@cvshealth.com |
|
|