Provider Demographics
NPI:1932821840
Name:ETAPE, GODLOVE EBONG (RPH)
Entity Type:Individual
Prefix:DR
First Name:GODLOVE
Middle Name:EBONG
Last Name:ETAPE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHESWOLD BLVD APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4121
Mailing Address - Country:US
Mailing Address - Phone:240-593-7736
Mailing Address - Fax:
Practice Address - Street 1:1306 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1501
Practice Address - Country:US
Practice Address - Phone:610-521-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist