Provider Demographics
NPI:1518516368
Name:IGBOANUGO, FLORENTYNA NNENNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FLORENTYNA
Middle Name:NNENNE
Last Name:IGBOANUGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5452
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-5452
Mailing Address - Country:US
Mailing Address - Phone:623-759-3607
Mailing Address - Fax:
Practice Address - Street 1:1960 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5783
Practice Address - Country:US
Practice Address - Phone:928-846-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist