Provider Demographics
NPI:1376856682
Name:AKPAN, IBORO
Entity Type:Individual
Prefix:
First Name:IBORO
Middle Name:
Last Name:AKPAN
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 1:590 N ALMA SCHOOL RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4413
Mailing Address - Country:US
Mailing Address - Phone:480-577-8726
Mailing Address - Fax:
Practice Address - Street 1:590 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4361
Practice Address - Country:US
Practice Address - Phone:480-719-8798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ651175Medicaid
AZ651175Medicaid