Provider Demographics
NPI:1831720085
Name:IHEANACHO, GODSON NZUBECHI JR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:GODSON
Middle Name:NZUBECHI
Last Name:IHEANACHO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2250
Mailing Address - Country:US
Mailing Address - Phone:512-584-0212
Mailing Address - Fax:
Practice Address - Street 1:15322 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3043
Practice Address - Country:US
Practice Address - Phone:216-851-1500
Practice Address - Fax:216-851-0602
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy