Provider Demographics
NPI:1275831067
Name:ISIBOR, EWERE S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EWERE
Middle Name:S
Last Name:ISIBOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROLLING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4315
Mailing Address - Country:US
Mailing Address - Phone:973-332-9761
Mailing Address - Fax:
Practice Address - Street 1:353 US HIGHWAY 202/206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2442
Practice Address - Country:US
Practice Address - Phone:908-725-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03026100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist