1396961991 NPI number — DR. EDEM TOM UDOH-AFAHA PHARM.D

Table of content: DR. EDEM TOM UDOH-AFAHA PHARM.D (NPI 1396961991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396961991 NPI number — DR. EDEM TOM UDOH-AFAHA PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UDOH-AFAHA
Provider First Name:
EDEM
Provider Middle Name:
TOM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396961991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93390-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-599-1767
Provider Business Mailing Address Fax Number:
559-366-4570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 SEQUOIA AVE STE 2
Provider Second Line Business Practice Location Address:
LINDSAY PHARMACY
Provider Business Practice Location Address City Name:
LINDSAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93247-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-562-7979
Provider Business Practice Location Address Fax Number:
559-366-4570
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH 39368 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHY 51148 . This is a "CALIFORNIA BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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