Provider Demographics
NPI:1063758696
Name:EZIRIM, EMMANUEL CHIDI (RPH)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:CHIDI
Last Name:EZIRIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 HARRISBURG PIKE
Mailing Address - Street 2:SUITE-L
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2141
Mailing Address - Country:US
Mailing Address - Phone:614-272-7000
Mailing Address - Fax:614-272-7011
Practice Address - Street 1:699 HARRISBURG PIKE
Practice Address - Street 2:SUITE-L
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2141
Practice Address - Country:US
Practice Address - Phone:614-272-7000
Practice Address - Fax:614-272-7011
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist