MEDICARE: LYNDA IKPEAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26025785A	IN

General Provider Information

NPI Number	:	1194124909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA IKPEAMA

Provider Business Mailing Address
First Line	:	428 WALLEN HILLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-7033
Country	:	US
Telephone Number	:	708-843-3854
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 WALLEN HILLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-7033
Country	:	US
Telephone Number	:	708-843-3854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	08/18/2014

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Directions to “ LYNDA IKPEAMA ” Practice Location

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