Provider Demographics
NPI:1700175254
Name:EKPO, IBORO D
Entity Type:Individual
Prefix:
First Name:IBORO
Middle Name:D
Last Name:EKPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 W FIGARDEN DR APT 131
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8614
Mailing Address - Country:US
Mailing Address - Phone:281-415-6442
Mailing Address - Fax:
Practice Address - Street 1:4258 W FIGARDEN DR APT 131
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8614
Practice Address - Country:US
Practice Address - Phone:281-415-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist