MEDICARE: DR. EHIKHUEMHEN ENAHOLO PHARMD

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	2019046056	MO

General Provider Information

NPI Number	:	1467080945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHIKHUEMHEN ENAHOLO PHARMD

Provider Business Mailing Address
First Line	:	5132 WATERMAN BLVD APT 209
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1137
Country	:	US
Telephone Number	:	773-699-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5132 WATERMAN BLVD APT 209
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1137
Country	:	US
Telephone Number	:	773-699-2707
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	03/30/2020

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Directions to “ DR. EHIKHUEMHEN ENAHOLO PHARMD” Practice Location

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