Provider Demographics
NPI:1376725317
Name:EZE, IJEOMA ANTHONIA
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:ANTHONIA
Last Name:EZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WACHS WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2526
Mailing Address - Country:US
Mailing Address - Phone:845-267-8564
Mailing Address - Fax:
Practice Address - Street 1:1179 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3386
Practice Address - Country:US
Practice Address - Phone:718-324-3668
Practice Address - Fax:718-324-8859
Is Sole Proprietor?:No
Enumeration Date:2007-12-01
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046630-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist