Healthcare Provider Details

I. General information

NPI: 1992035661
Provider Name (Legal Business Name): FELIX OGHOGHO OBASUYI PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 LANE AVE S SUITE 9
JACKSONVILLE FL
32205-6284
US

IV. Provider business mailing address

1233 LANE AVE S SUITE 9
JACKSONVILLE FL
32205-6284
US

V. Phone/Fax

Practice location:
  • Phone: 904-505-9720
  • Fax: 904-693-6684
Mailing address:
  • Phone: 904-505-9720
  • Fax: 904-693-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS36946
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number45163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: