Provider Demographics
NPI:1912282898
Name:IBESON, CHRIS UCHE (BS PHARM)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:UCHE
Last Name:IBESON
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 W SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1107
Mailing Address - Country:US
Mailing Address - Phone:517-703-0537
Mailing Address - Fax:
Practice Address - Street 1:6421 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1107
Practice Address - Country:US
Practice Address - Phone:517-703-0537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist