Provider Demographics
NPI:1023639655
Name:IKE, PRINCESS C (PHARMD)
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:C
Last Name:IKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14220 NORTHBROOK DR STE 100B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5045
Mailing Address - Country:US
Mailing Address - Phone:210-403-0429
Mailing Address - Fax:
Practice Address - Street 1:14220 NORTHBROOK DR STE 100B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5045
Practice Address - Country:US
Practice Address - Phone:210-403-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653151835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist