Healthcare Provider Details

I. General information

NPI: 1780307447
Provider Name (Legal Business Name): EMEKA OBIRIIBE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W ELM AVE
HANOVER PA
17331-5125
US

IV. Provider business mailing address

625 W ELM AVE
HANOVER PA
17331-5125
US

V. Phone/Fax

Practice location:
  • Phone: 717-524-5712
  • Fax:
Mailing address:
  • Phone: 717-524-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454223
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: