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1003589250 NPI number — DIANE ETONDE IKOME PHARMD, RPH

NPI Number: 1003589250
Health Care Provider/Practitioner: DIANE ETONDE IKOME PHARMD, RPH

Information about “1003589250” NPI (DIANE ETONDE IKOME PHARMD, RPH) exists in 1003589250 in HTML format HTML  |  1003589250 in plain Text format TXT  |  1003589250 in PDF (Portable Document Format) PDF  |  1003589250 in an XML format XML  formats.

NPI Number : 1003589250 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003589250",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IKOME",
    "FirstName": "DIANE",
    "MiddleName": "ETONDE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD, RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "418 BERMUDA LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40213-3332",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "270-519-4985",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10445 DIXIE HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOUISVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40272-3953",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "502-935-3265",
    "PracticeLocationAddressFaxNumber": "502-935-3423",
    "EnumerationDate": "07/25/2021",
    "LastUpdateDate": "04/30/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "022162",
        "LicenseNumberStateCode": "KY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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