1750106050 NPI number — MAUREEN IKPEAZU PHARMACIST

Table of content: MAUREEN IKPEAZU PHARMACIST (NPI 1750106050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750106050 NPI number — MAUREEN IKPEAZU PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IKPEAZU
Provider First Name:
MAUREEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IKPEAZU-COULTER
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CLINICAL PHARMACIST
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750106050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 BURLING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76712-7577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-222-2364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E CENTRAL TEXAS EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76541-9162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-526-4258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2024

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:  50011 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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