Provider Demographics
NPI:1659689743
Name:IJEOMA OBINWANNE
Entity Type:Organization
Organization Name:IJEOMA OBINWANNE
Other - Org Name:EL MONTE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBINWANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-579-6277
Mailing Address - Street 1:10808 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2628
Mailing Address - Country:US
Mailing Address - Phone:626-579-6277
Mailing Address - Fax:626-579-6739
Practice Address - Street 1:10808 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2628
Practice Address - Country:US
Practice Address - Phone:626-579-6277
Practice Address - Fax:626-579-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY504493336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127734OtherPK