Provider Demographics
NPI:1194092098
Name:IZUCHUKWU, MICHELE ANTHEA (RPH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANTHEA
Last Name:IZUCHUKWU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 SINCLAIR TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2624
Mailing Address - Country:US
Mailing Address - Phone:636-697-8512
Mailing Address - Fax:
Practice Address - Street 1:550 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2152
Practice Address - Country:US
Practice Address - Phone:973-473-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R103464600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist