1588471551 NPI number — MR. PAUL EMMANUEL NDJABE PHARMACIST

Table of content: MR. PAUL EMMANUEL NDJABE PHARMACIST (NPI 1588471551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588471551 NPI number — MR. PAUL EMMANUEL NDJABE PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NDJABE
Provider First Name:
PAUL
Provider Middle Name:
EMMANUEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NDJABE
Provider Other First Name:
PAUL
Provider Other Middle Name:
EMMANUEL
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588471551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 PATRIOT LN APT 228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32539-7404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-879-3426
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 PATRIOT LN APT 228
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32539-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-879-3426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2024

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:  PS67978 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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