Provider Demographics
NPI:1437752706
Name:IGWEBUIKE, LEO
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:IGWEBUIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 DIRKSEN DR APT F14
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3972
Mailing Address - Country:US
Mailing Address - Phone:614-778-6359
Mailing Address - Fax:
Practice Address - Street 1:1601 RINEHART RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7392
Practice Address - Country:US
Practice Address - Phone:407-321-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist