Provider Demographics
NPI:1376826628
Name:IBEKWE, PASCHAL N (RPH)
Entity type:Individual
Prefix:
First Name:PASCHAL
Middle Name:N
Last Name:IBEKWE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MARTIN LUTHER KING
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2207
Mailing Address - Country:US
Mailing Address - Phone:973-672-6317
Mailing Address - Fax:973-672-6129
Practice Address - Street 1:508 MARTIN LUTHER KING
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2207
Practice Address - Country:US
Practice Address - Phone:973-672-6317
Practice Address - Fax:973-672-6129
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02496100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8622241339Medicaid
NJ8622241339Medicaid
NJ8622241339Medicare NSC