Healthcare Provider Details

I. General information

NPI: 1922603893
Provider Name (Legal Business Name): CHIEBONNAM PASCHALINE OGBENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6665 TAFT ST
HOLLYWOOD FL
33024-4010
US

IV. Provider business mailing address

13215 SW 47TH ST
MIRAMAR FL
33027-3168
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-0300
  • Fax: 954-981-1882
Mailing address:
  • Phone: 786-554-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS32367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: