Provider Demographics
NPI:1265809982
Name:IFEDIORA, ELIZABETH UCHENNA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:UCHENNA
Last Name:IFEDIORA
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 1:4719 N SPAGO DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-6706
Mailing Address - Country:US
Mailing Address - Phone:408-457-4432
Mailing Address - Fax:
Practice Address - Street 1:4719 NORTH SPAGO DRIVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:408-457-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist