Healthcare Provider Details

I. General information

NPI: 1376826628
Provider Name (Legal Business Name): PASCHAL N IBEKWE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MARTIN LUTHER KING
EAST ORANGE NJ
07018-2207
US

IV. Provider business mailing address

508 MARTIN LUTHER KING
EAST ORANGE NJ
07018-2207
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-6317
  • Fax: 973-672-6129
Mailing address:
  • Phone: 973-672-6317
  • Fax: 973-672-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02496100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: