Healthcare Provider Details

I. General information

NPI: 1427186865
Provider Name (Legal Business Name): IFEOMA OBIORA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N 21ST ST UNIT 39
PHOENIX AZ
85016-5575
US

IV. Provider business mailing address

4301 N 21ST ST UNIT 39
PHOENIX AZ
85016-5575
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-0553
  • Fax:
Mailing address:
  • Phone: 602-274-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: