Healthcare Provider Details

I. General information

NPI: 1053241265
Provider Name (Legal Business Name): MAGNUS OGBENNA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12 AVENUE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12 AVENUE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 786-554-1105
  • Fax:
Mailing address:
  • Phone: 786-554-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPS24093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: