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General NPI Number Information
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NPI Number | 1417568254
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Entity Type | Individual
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Provider Name | EKWERE JOHNSON EKPO
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Gender | Male
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 1800 BROWN BLVD
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City | ARLINGTON
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State | TX
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Zip | 76006-4602
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Country | US
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Telephone | 770-519-3604
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Fax | 817-459-2880
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Provider Business Mailing Address
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Address Line | 6462 RIVIERA DR
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City | IRVING
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State | TX
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Zip | 75039-4160
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Country | US
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Telephone | 770-519-3604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 53320
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License Number State | TX
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