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1386068765 NPI number — AUGUSTINE EHIMEN IRIOGBE

NPI Number: 1386068765
Health Care Provider/Practitioner: AUGUSTINE EHIMEN IRIOGBE

Information about “1386068765” NPI (AUGUSTINE EHIMEN IRIOGBE) exists in 1386068765 in HTML format HTML  |  1386068765 in plain Text format TXT  |  1386068765 in PDF (Portable Document Format) PDF  |  1386068765 in an XML format XML  formats.

NPI Number : 1386068765 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386068765",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IRIOGBE",
    "FirstName": "AUGUSTINE",
    "MiddleName": "EHIMEN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3929 IRISH HILLS DR APT 1A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH BEND",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46614-6529",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "563-343-8468",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "15005 STATE ROAD 23",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRANGER",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46530-9666",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "574-271-2553",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/06/2014",
    "LastUpdateDate": "02/06/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "26025218A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "21927",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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