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General NPI Number Information
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NPI Number | 1841957503
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Entity Type | Individual
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Provider Name | ISRAEL ENECHUKWU PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 1611 N FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33805-3107
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Country | US
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Telephone | 863-940-4733
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Fax | 863-940-4734
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Provider Business Mailing Address
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Address Line | PO BOX 90014
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City | LAKELAND
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State | FL
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Zip | 33804-0014
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Country | US
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Telephone | 863-940-4733
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Fax | 863-940-4734
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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 | PS43432
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License Number State | FL
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