Healthcare Provider Details

I. General information

NPI: 1043931314
Provider Name (Legal Business Name): DEEDEE IBEKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEDEE IBEKU PHARM.D

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N COLONY RD
WALLINGFORD CT
06492-3109
US

IV. Provider business mailing address

605 N COLONY RD
WALLINGFORD CT
06492-3109
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033909
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: