Provider Demographics
NPI:1194182394
Name:ANIEROBI, IGNATIUS NNAMDI
Entity Type:Individual
Prefix:
First Name:IGNATIUS
Middle Name:NNAMDI
Last Name:ANIEROBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2865
Mailing Address - Country:US
Mailing Address - Phone:240-441-4008
Mailing Address - Fax:
Practice Address - Street 1:3400 MILITARY HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4230
Practice Address - Country:US
Practice Address - Phone:318-640-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist