Provider Demographics
NPI:1316210537
Name:IHEKWOEME, IJEOMA STELLA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IJEOMA
Middle Name:STELLA
Last Name:IHEKWOEME
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 WRANGLER CT
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-5821
Mailing Address - Country:US
Mailing Address - Phone:707-839-0734
Mailing Address - Fax:
Practice Address - Street 1:411 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4416
Practice Address - Country:US
Practice Address - Phone:707-443-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist