Provider Demographics
NPI:1124375902
Name:IBEABUCHI, NNEKA (PHARM D)
Entity Type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:IBEABUCHI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BRADLEE ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3205
Mailing Address - Country:US
Mailing Address - Phone:617-417-7900
Mailing Address - Fax:
Practice Address - Street 1:1478 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2607
Practice Address - Country:US
Practice Address - Phone:781-444-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist