Iheanacho Ahamefula Ezirim
Individual provider Active NPI Pharmacist · Bee Cave, TX
NPI 1427360403 · NPPES record last updated May 10, 2018
Key facts
- NPI
- 1427360403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 47301 (TX)
- Practice address
- 3500 Ranch Road 620 S Ste A100
Bee Cave, TX 78738-7154 - Phone
- (512) 502-5161
- Fax
- (512) 502-5227
- NPI assigned
- Jul 8, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeway Pharmacy LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 47301 | TX | Yes |
Addresses
Primary practice location
3500 Ranch Road 620 S Ste A100
Bee Cave, TX 78738-7154
Mailing address
311 Montalcino Blvd
Lakeway, TX 78734-5089
Phone (409) 504-2962
Other providers in Bee Cave, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.