Provider Demographics
NPI:1487214581
Name:EZEPUE, JULIUS CHUKWUGEKWU
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:CHUKWUGEKWU
Last Name:EZEPUE
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 1:3001 SE LAKE WEIR AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6728
Mailing Address - Country:US
Mailing Address - Phone:786-202-7867
Mailing Address - Fax:352-484-0984
Practice Address - Street 1:6230 SW HIGHWAY 200 UNIT 1
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-5606
Practice Address - Country:US
Practice Address - Phone:783-202-7867
Practice Address - Fax:352-484-0984
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32172OtherPHARMACY LICENSE