Healthcare Provider Details

I. General information

NPI: 1528811247
Provider Name (Legal Business Name): SIMON AMOFAH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 COMMERCE PARK DR
ORLANDO FL
32819-8601
US

IV. Provider business mailing address

2354 COMMERCE PARK DR
ORLANDO FL
32819-8601
US

V. Phone/Fax

Practice location:
  • Phone: 877-453-4566
  • Fax:
Mailing address:
  • Phone: 877-453-4566
  • Fax: 866-537-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS68479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: