Healthcare Provider Details

I. General information

NPI: 1194008045
Provider Name (Legal Business Name): FREDERICK OWUSU-OFORI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 S HWY 27
CLERMONT FL
34711-5383
US

IV. Provider business mailing address

3648 PEACEFUL VALLEY DR
CLERMONT FL
34711-8916
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-8029
  • Fax:
Mailing address:
  • Phone: 352-243-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS39624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: