Provider Demographics
NPI:1902195647
Name:IBEKWE, OKWUDILI IGNATIUS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:OKWUDILI
Middle Name:IGNATIUS
Last Name:IBEKWE
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 1:205 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-7720
Mailing Address - Country:US
Mailing Address - Phone:606-356-6335
Mailing Address - Fax:
Practice Address - Street 1:380 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1536
Practice Address - Country:US
Practice Address - Phone:606-783-1581
Practice Address - Fax:606-780-1331
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist