Provider Demographics
NPI:1194250688
Name:OTUONYE, EBUBE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:EBUBE
Middle Name:
Last Name:OTUONYE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 E 21ST ST N STE 121
Mailing Address - Street 2:NEIGHBORHOOD PHARMACY
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-1976
Mailing Address - Country:US
Mailing Address - Phone:316-665-4427
Mailing Address - Fax:
Practice Address - Street 1:2251 E 21ST ST N STE 121
Practice Address - Street 2:NEIGHBORHOOD PHARMACY
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-1976
Practice Address - Country:US
Practice Address - Phone:316-665-4427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12971183500000X, 1835N0905X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care