Provider Demographics
NPI:1669746780
Name:EKEYA, IHEKE O (PHARMD)
Entity type:Individual
Prefix:
First Name:IHEKE
Middle Name:O
Last Name:EKEYA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:IKE
Other - Middle Name:O
Other - Last Name:EKEYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:717 NW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2495
Mailing Address - Country:US
Mailing Address - Phone:503-473-6316
Mailing Address - Fax:
Practice Address - Street 1:PEACEHEALTH SW MEDICAL CENTER
Practice Address - Street 2:400 NE MOTHER JOSEPH PL
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-514-7654
Practice Address - Fax:360-514-3146
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2022-07-21
Deactivation Date:2021-01-25
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
ORRPH0012681183500000X
WAPH60215211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist