Provider Demographics
NPI:1104273507
Name:EKEMEZIE, BLESSING
Entity type:Individual
Prefix:
First Name:BLESSING
Middle Name:
Last Name:EKEMEZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 ATTLEBORO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2713
Mailing Address - Country:US
Mailing Address - Phone:571-213-6371
Mailing Address - Fax:
Practice Address - Street 1:7814 ATTLEBORO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2713
Practice Address - Country:US
Practice Address - Phone:571-213-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020102541835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care