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General NPI Number Information
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NPI Number | 1760766141
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Entity Type | Individual
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Provider Name | MR. BONIFACE IFEANYI EZEOKOLI
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Gender | Male
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 9475 E PICKWICK CIR #28
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City | TAYLOR
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State | MI
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Zip | 48180-3857
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Country | US
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Telephone | 313-334-3202
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Fax |
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Provider Business Mailing Address
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Address Line | 9475 E PICKWICK CIR #28
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City | TAYLOR
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State | MI
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Zip | 48180-3857
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Country | US
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Telephone | 313-334-3202
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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 | 5302036557
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License Number State | MI
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