Healthcare Provider Details

I. General information

NPI: 1386009173
Provider Name (Legal Business Name): ERIC NKABYO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W BELTLINE HWY
MADISON WI
53713-2316
US

IV. Provider business mailing address

2601 W BELTLINE HWY
MADISON WI
53713-2316
US

V. Phone/Fax

Practice location:
  • Phone: 608-729-1587
  • Fax:
Mailing address:
  • Phone: 608-729-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15022-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: