Provider Demographics
NPI:1215339981
Name:OMEKARA-NDUBUISI, IJEOMA
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:OMEKARA-NDUBUISI
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 1:14893 NW PURVIS DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-0946
Mailing Address - Country:US
Mailing Address - Phone:503-442-6982
Mailing Address - Fax:
Practice Address - Street 1:14893 NW PURVIS DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-0946
Practice Address - Country:US
Practice Address - Phone:503-442-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist