Provider Demographics
NPI:1992495766
Name:EKWEALOR, IKE MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:IKE
Middle Name:MARTIN
Last Name:EKWEALOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4320
Mailing Address - Country:US
Mailing Address - Phone:765-969-5212
Mailing Address - Fax:765-939-3674
Practice Address - Street 1:1515 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4320
Practice Address - Country:US
Practice Address - Phone:765-969-5212
Practice Address - Fax:765-939-3674
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015974A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist