Provider Demographics
NPI:1588942551
Name:OGBUDINKPA, EZIDIMMA ADANNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EZIDIMMA
Middle Name:ADANNA
Last Name:OGBUDINKPA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5602
Mailing Address - Country:US
Mailing Address - Phone:215-289-4566
Mailing Address - Fax:
Practice Address - Street 1:3900 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5602
Practice Address - Country:US
Practice Address - Phone:215-289-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist