Provider Demographics
NPI:1912482357
Name:MALANGE, ELIAS IKOME (MD, PHARMD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:IKOME
Last Name:MALANGE
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 BECKETT CENTER DR STE 325
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5023
Mailing Address - Country:US
Mailing Address - Phone:513-389-7634
Mailing Address - Fax:513-389-7833
Practice Address - Street 1:8050 BECKETT CENTER DR STE 325
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5023
Practice Address - Country:US
Practice Address - Phone:513-389-7634
Practice Address - Fax:513-389-7833
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03338177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist