Provider Demographics
NPI:1982968921
Name:EZEBUIRO, ADAEZE IFEOMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADAEZE
Middle Name:IFEOMA
Last Name:EZEBUIRO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 HUNTLEY CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2983
Mailing Address - Country:US
Mailing Address - Phone:301-520-3076
Mailing Address - Fax:
Practice Address - Street 1:2508 HUNTLEY CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2983
Practice Address - Country:US
Practice Address - Phone:301-520-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164781835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist