Healthcare Provider Details

I. General information

NPI: 1760766364
Provider Name (Legal Business Name): NORDIA OGUNBUNMI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2011
Last Update Date: 10/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 N STATE ROAD 7
LAUDERDALE LAKES FL
33313-1913
US

IV. Provider business mailing address

3521 W HILLSBORO BLVD APT J202
COCONUT CREEK FL
33073-2098
US

V. Phone/Fax

Practice location:
  • Phone: 954-485-9161
  • Fax:
Mailing address:
  • Phone: 954-980-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS39501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: