Healthcare Provider Details

I. General information

NPI: 1104273507
Provider Name (Legal Business Name): BLESSING EKEMEZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7814 ATTLEBORO DR
SPRINGFIELD VA
22153-2713
US

IV. Provider business mailing address

7814 ATTLEBORO DR
SPRINGFIELD VA
22153-2713
US

V. Phone/Fax

Practice location:
  • Phone: 571-213-6371
  • Fax:
Mailing address:
  • Phone: 571-213-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202010254
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: