Healthcare Provider Details

I. General information

NPI: 1174712053
Provider Name (Legal Business Name): ONYEMA A. EZEANYA PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 10TH ST E
PALMETTO FL
34221-4013
US

IV. Provider business mailing address

725 KENSINGTON LAKE CIR
BRANDON FL
33511-3889
US

V. Phone/Fax

Practice location:
  • Phone: 941-729-2021
  • Fax:
Mailing address:
  • Phone: 850-528-4413
  • Fax: 941-729-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS39323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: