Provider Demographics
NPI:1902406358
Name:EKHAEYEMHE, JOHNSON
Entity Type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:EKHAEYEMHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BUHL MORTON RD APT 703
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1353
Mailing Address - Country:US
Mailing Address - Phone:513-765-0214
Mailing Address - Fax:
Practice Address - Street 1:2145 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1873
Practice Address - Country:US
Practice Address - Phone:740-441-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist