MEDICARE: LILIAN CHIAMAKA EJIOFOR

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	17922	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7022808420	OTHER		PHONE NUMBER

General Provider Information

NPI Number	:	1689205825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIAN CHIAMAKA EJIOFOR

Provider Business Mailing Address
First Line	:	4325 SAN GABRIEL HILL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 W ANN RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7259
Country	:	US
Telephone Number	:	702-656-3425
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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