Provider Demographics
NPI:1578861654
Name:EJINDU, LAWRENCE NDUBUISI (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:NDUBUISI
Last Name:EJINDU
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9390 FORD AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6421
Mailing Address - Country:US
Mailing Address - Phone:912-321-9428
Mailing Address - Fax:912-459-4404
Practice Address - Street 1:9390 FORD AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6421
Practice Address - Country:US
Practice Address - Phone:912-321-9428
Practice Address - Fax:912-459-4404
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist