Provider Demographics
NPI:1952554446
Name:EZEABASILI, SYLVESTER IFEANYI (MPHARM)
Entity Type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:IFEANYI
Last Name:EZEABASILI
Suffix:
Gender:M
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 HASKELL DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3970
Mailing Address - Country:US
Mailing Address - Phone:615-541-1926
Mailing Address - Fax:
Practice Address - Street 1:5171 SAM JARED DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1382
Practice Address - Country:US
Practice Address - Phone:615-904-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23486183500000X
MI5302035192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist