Provider Demographics
NPI:1679976591
Name:AHUKANNA, IHEANYI
Entity type:Individual
Prefix:
First Name:IHEANYI
Middle Name:
Last Name:AHUKANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOGWOOD DR APT 304
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-7540
Mailing Address - Country:US
Mailing Address - Phone:973-951-0170
Mailing Address - Fax:
Practice Address - Street 1:1000 DIVISION RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2078
Practice Address - Country:US
Practice Address - Phone:401-884-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist