Provider Demographics
NPI:1720386394
Name:IFEADIKE, UMEADI E JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:UMEADI
Middle Name:E
Last Name:IFEADIKE
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:253 SEDGEWICK TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4588
Mailing Address - Country:US
Mailing Address - Phone:678-491-3752
Mailing Address - Fax:770-978-0642
Practice Address - Street 1:2979 FIVE FORKS TRICKUM RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5873
Practice Address - Country:US
Practice Address - Phone:770-979-8121
Practice Address - Fax:770-978-0642
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020970183500000X
ALRPH14240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist