Provider Demographics
NPI:1275183865
Name:EZEUKWU, ANENE N
Entity Type:Individual
Prefix:MR
First Name:ANENE
Middle Name:N
Last Name:EZEUKWU
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 1:22708 KESWICK ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5431
Mailing Address - Country:US
Mailing Address - Phone:818-585-1457
Mailing Address - Fax:818-882-5015
Practice Address - Street 1:20177 SATICOY ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2506
Practice Address - Country:US
Practice Address - Phone:188-825-0108
Practice Address - Fax:818-882-5015
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist