Most Relevant Information
Provider Data
| NPI Number: | 1003589250 |
| Provider Name: | DIANE ETONDE IKOME PHARMD, RPH |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 022162 |
Most Important Dates
| Enumeration Date: | 07/25/2021 |
| Last Updated: | 04/30/2023 |
Provider Practice Location
10445 DIXIE HWY
LOUISVILLE
KY
402723953
Practice Location Phone/Fax
| Phone: | 5029353265 |
| Fax: | 5029353423 |
Provider Mailing Location
418 BERMUDA LN
LOUISVILLE
KY
402133332
Provider Mailing Phone/Fax
| Phone: | 2705194985 |
| Fax: |