MEDICARE: PETER EJIOFOR

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	51170	TX

General Provider Information

NPI Number	:	1578989349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER EJIOFOR

Provider Business Mailing Address
First Line	:	5061 MAIN ST
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-3947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5061 MAIN ST
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-3947
Country	:	US
Telephone Number	:	225-654-1335
Fax Number	:

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

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	01/06/2023

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Directions to “ PETER EJIOFOR ” Practice Location

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