Provider Demographics
NPI:1972824001
Name:IREGBULEM, IGNATIUS AMECHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:IGNATIUS
Middle Name:AMECHI
Last Name:IREGBULEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 RODEO PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5815
Mailing Address - Country:US
Mailing Address - Phone:323-295-3323
Mailing Address - Fax:323-295-6292
Practice Address - Street 1:3566 RODEO PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5815
Practice Address - Country:US
Practice Address - Phone:323-295-3323
Practice Address - Fax:323-295-6292
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist