Provider Demographics
NPI:1154986800
Name:EBENEZER FAMILY PHARMACY INC
Entity type:Organization
Organization Name:EBENEZER FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:NWAKAEGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHUKWUNENYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:302-652-1994
Mailing Address - Street 1:PO BOX 30410
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7410
Mailing Address - Country:US
Mailing Address - Phone:302-652-1994
Mailing Address - Fax:302-652-6960
Practice Address - Street 1:1416 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3905
Practice Address - Country:US
Practice Address - Phone:302-652-1994
Practice Address - Fax:302-652-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy