Provider Demographics
NPI:1609182229
Name:EZEALAJI, ALLWELL (RPH)
Entity Type:Individual
Prefix:
First Name:ALLWELL
Middle Name:
Last Name:EZEALAJI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2156
Mailing Address - Country:US
Mailing Address - Phone:908-298-1911
Mailing Address - Fax:
Practice Address - Street 1:35 MILL RD
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1009
Practice Address - Country:US
Practice Address - Phone:973-372-0733
Practice Address - Fax:973-372-1283
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02070000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist