Provider Demographics
NPI:1417735358
Name:IMADE, UHUNOMA EDNA
Entity Type:Individual
Prefix:MRS
First Name:UHUNOMA
Middle Name:EDNA
Last Name:IMADE
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 1:5001 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3503
Mailing Address - Country:US
Mailing Address - Phone:347-557-0959
Mailing Address - Fax:
Practice Address - Street 1:5001 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3503
Practice Address - Country:US
Practice Address - Phone:347-557-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist