Healthcare Provider Details

I. General information

NPI: 1679417059
Provider Name (Legal Business Name): ONYEKACHI JOHN ROBERT-EZE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W MAIN ST
BOONVILLE IN
47601-1567
US

IV. Provider business mailing address

905 W MAIN ST
BOONVILLE IN
47601-1567
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-8128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: