Provider Demographics
NPI:1952732570
Name:EZIDINMA, JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:EZIDINMA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NKECHINYERE
Other - Middle Name:
Other - Last Name:EZIDINMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3302 W CRYSTAL ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2375
Mailing Address - Country:US
Mailing Address - Phone:630-418-0252
Mailing Address - Fax:
Practice Address - Street 1:3302 W CRYSTAL ST
Practice Address - Street 2:UNIT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2375
Practice Address - Country:US
Practice Address - Phone:630-418-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA00159291835P0018X
IL051.2898131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist