Provider Demographics
NPI:1720363609
Name:ERINMWINGBOVO, ISAAC E (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:E
Last Name:ERINMWINGBOVO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 BRUCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2308
Mailing Address - Country:US
Mailing Address - Phone:916-682-7407
Mailing Address - Fax:
Practice Address - Street 1:8275 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2308
Practice Address - Country:US
Practice Address - Phone:916-682-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH46383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist