Individual
LAWRENCE EJIOFO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 460-1474
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 460-1474
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26027931A
IN
Other
Enumeration date
08/03/2020
Last updated
08/03/2020
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