Active NPI
Nonyelum Ikediugwu
- Pharmacist
- East Orange, NJ
National Provider Identifier
1750993820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RS00606200
- Practice address
- 508 Main St
East Orange, NJ 07018-2207 - Phone
- (973) 672-6317
- NPI assigned
- Aug 20, 2020
- Last updated
- Aug 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI03978700 | NJ | |
| Pharmacist | 183500000X | 28RS00606200 | NJ | Primary |
Addresses
Primary practice location
508 Main St
East Orange, NJ 07018-2207
Mailing address
1771 Walker Ave Apt a
Union, NJ 07083-4453
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
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03978700 | NJ | MD | Pharmacist |
| 28RS00606200 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
508 Martin Luther King
East Orange, NJ 07018
Phone (973) 477-3688
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": "1597881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597881600000",
"number": "1750993820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1771 WALKER AVE APT A",
"city": "UNION",
"state": "NJ",
"postal_code": "070834453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 MAIN ST",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "070182207",
"telephone_number": "973-672-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IKEDIUGWU",
"first_name": "NONYELUM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-20",
"last_updated": "2020-08-20",
"certification_date": "2020-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03978700",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RS00606200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.