Provider Demographics
NPI:1194124909
Name:IKPEAMA, LYNDA
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:IKPEAMA
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 1:428 WALLEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-7033
Mailing Address - Country:US
Mailing Address - Phone:708-843-3854
Mailing Address - Fax:
Practice Address - Street 1:428 WALLEN HILLS DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-7033
Practice Address - Country:US
Practice Address - Phone:708-843-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025785A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist