Healthcare Provider Details

I. General information

NPI: 1013235225
Provider Name (Legal Business Name): GLORIA FLORA AKINKUNMI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RUTHAR DR
NEWARK DE
19711-8025
US

IV. Provider business mailing address

111 RUTHAR DR
NEWARK DE
19711-8025
US

V. Phone/Fax

Practice location:
  • Phone: 800-727-0123
  • Fax:
Mailing address:
  • Phone: 800-727-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberA1-0003716
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: