MEDICARE: MR. BENJAMIN EZEKWE PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	044670	MO

General Provider Information

NPI Number	:	1356946339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN EZEKWE PHARMACIST

Provider Business Mailing Address
First Line	:	2435 INDEPENDENCE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-2401
Country	:	US
Telephone Number	:	816-483-6464
Fax Number	:	816-483-0616

Provider Business Practice Location Address
First Line	:	2435 INDEPENDENCE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-2401
Country	:	US
Telephone Number	:	816-483-6464
Fax Number	:	816-483-0616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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