Healthcare Provider Details

I. General information

NPI: 1649875568
Provider Name (Legal Business Name): DOITE MOJISOLA JOY OWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CANAL ST
MILLBURY MA
01527-3252
US

IV. Provider business mailing address

47 MISCOE RD
WORCESTER MA
01604-3517
US

V. Phone/Fax

Practice location:
  • Phone: 508-865-8805
  • Fax: 508-581-9526
Mailing address:
  • Phone: 508-410-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH232951
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: