Provider Demographics
NPI:1043594708
Name:EZENEKWE, ADAORA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ADAORA
Middle Name:
Last Name:EZENEKWE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50673 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4932
Mailing Address - Country:US
Mailing Address - Phone:630-210-1198
Mailing Address - Fax:
Practice Address - Street 1:15005 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9666
Practice Address - Country:US
Practice Address - Phone:574-271-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023556A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist