Provider Demographics
NPI:1134636467
Name:IKERI, IKENNA CHINAKA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:IKENNA
Middle Name:CHINAKA
Last Name:IKERI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 VALLEY BLVD # 4-203
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1140
Mailing Address - Country:US
Mailing Address - Phone:323-602-9405
Mailing Address - Fax:
Practice Address - Street 1:5530 LAKE ISABELLA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-5621
Practice Address - Fax:760-379-5073
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist