Provider Demographics
NPI:1598348518
Name:EZEALOR, NNENNA ANTHONIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NNENNA
Middle Name:ANTHONIA
Last Name:EZEALOR
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 1:2 SUNSHINE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3179
Mailing Address - Country:US
Mailing Address - Phone:908-590-0677
Mailing Address - Fax:
Practice Address - Street 1:2 DON CONNOR BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3436
Practice Address - Country:US
Practice Address - Phone:732-928-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04164900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist