Healthcare Provider Details

I. General information

NPI: 1942024906
Provider Name (Legal Business Name): GBENGA AGUEBOR PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16550 NE 6TH AVE
NORTH MIAMI BEACH FL
33162-3646
US

IV. Provider business mailing address

7960 PLANTATION BLVD
MIRAMAR FL
33023-2454
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-6172
  • Fax:
Mailing address:
  • Phone: 954-536-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS67817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: