NPIMap

Individual provider Active NPI

Augustine Ehimen Iriogbe

  • Pharmacist
  • Granger, IN
National Provider Identifier
1386068765
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
26025218A Issued in IN
Practice address
15005 State Road 23
Granger, IN 46530-9666
Phone
(574) 271-2553
NPI assigned
Feb 6, 2014
Last updated
Feb 6, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 26025218A IN Primary
Pharmacist 183500000X 21927 IA

Addresses

Primary practice location

15005 State Road 23
Granger, IN 46530-9666

Mailing address

3929 Irish Hills Dr Apt 1a
South Bend, IN 46614-6529
Phone (563) 343-8468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21927IAMDPharmacist
26025218AINMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391644800000",
    "number": "1386068765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3929 IRISH HILLS DR APT 1A",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466146529",
            "telephone_number": "563-343-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15005 STATE ROAD 23",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309666",
            "telephone_number": "574-271-2553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRIOGBE",
        "first_name": "AUGUSTINE",
        "middle_name": "EHIMEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-06",
        "last_updated": "2014-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26025218A",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "21927",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.