Healthcare Provider Details

I. General information

NPI: 1336358191
Provider Name (Legal Business Name): CHIMEZIRI OSCAR MBIONWU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801-D W. COLONIAL DR
ORLANDO FL
32818
US

IV. Provider business mailing address

2183 HEATHWOOD CIR
ORLANDO FL
32828-4604
US

V. Phone/Fax

Practice location:
  • Phone: 407-291-1236
  • Fax: 407-291-1797
Mailing address:
  • Phone: 407-273-4801
  • Fax: 407-291-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS28855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: