Provider Demographics
NPI:1225656002
Name:IFIANAYI, GIDEON (MS, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GIDEON
Middle Name:
Last Name:IFIANAYI
Suffix:
Gender:M
Credentials:MS, PHARMD
Other - Prefix:
Other - First Name:GIDEON
Other - Middle Name:
Other - Last Name:IFIANAYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PHARMD
Mailing Address - Street 1:PO BOX 4521
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4521
Mailing Address - Country:US
Mailing Address - Phone:847-275-8539
Mailing Address - Fax:
Practice Address - Street 1:8556 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2377
Practice Address - Country:US
Practice Address - Phone:847-275-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist