Healthcare Provider Details

I. General information

NPI: 1376863530
Provider Name (Legal Business Name): IFEOMA M AKUMUO BSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 S BROAD ST
WOODBURY NJ
08096-2410
US

IV. Provider business mailing address

5 MARINER DR
SEWELL NJ
08080-1918
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-1173
  • Fax:
Mailing address:
  • Phone: 856-582-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02770300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number28RI02770300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: