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General NPI Number Information
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NPI Number | 1518516368
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Entity Type | Individual
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Provider Name | FLORENTYNA NNENNE IGBOANUGO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1960 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5783
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Country | US
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Telephone | 928-846-8818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5452
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City | GLENDALE
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State | AZ
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Zip | 85312-5452
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Country | US
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Telephone | 623-759-3607
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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 | S024075
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License Number State | AZ
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