Provider Demographics
NPI:1770039018
Name:EZEKWE, NKEMDILIM
Entity Type:Individual
Prefix:
First Name:NKEMDILIM
Middle Name:
Last Name:EZEKWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12027 223RD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2025
Mailing Address - Country:US
Mailing Address - Phone:718-285-9909
Mailing Address - Fax:
Practice Address - Street 1:ST. BARNABAS HOSPITAL
Practice Address - Street 2:4422 3RD AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-285-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049677-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist