Provider Demographics
NPI:1750106050
Name:IKPEAZU, MAUREEN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:IKPEAZU
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:IKPEAZU-COULTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLINICAL PHARMACIST
Mailing Address - Street 1:6500 BURLING ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7577
Mailing Address - Country:US
Mailing Address - Phone:857-222-2364
Mailing Address - Fax:
Practice Address - Street 1:1000 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9162
Practice Address - Country:US
Practice Address - Phone:254-526-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist