Provider Demographics
NPI:1578240552
Name:NKANYIMUO REAL ESTATE LLC
Entity Type:Organization
Organization Name:NKANYIMUO REAL ESTATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:NKIRU
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-652-7546
Mailing Address - Street 1:BLUE HILL PHARMACY
Mailing Address - Street 2:320 BLUE HILL AVE.
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1951
Mailing Address - Country:US
Mailing Address - Phone:161-765-2754
Mailing Address - Fax:617-652-7561
Practice Address - Street 1:BLUE HILL PHARMACY
Practice Address - Street 2:320 BLUE HILL AVE.
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1951
Practice Address - Country:US
Practice Address - Phone:161-765-2754
Practice Address - Fax:617-652-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy