Provider Demographics
NPI:1326693391
Name:OGBONNA, IFEANYI ISRAEL (RPH)
Entity Type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:ISRAEL
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 HICKORY WOODS DR NE APT 132
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6359
Mailing Address - Country:US
Mailing Address - Phone:513-823-5270
Mailing Address - Fax:
Practice Address - Street 1:10 E WILSON BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7331
Practice Address - Country:US
Practice Address - Phone:301-790-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist