Healthcare Provider Details

I. General information

NPI: 1255796819
Provider Name (Legal Business Name): DR. ANAYO THEODORA OGBONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WARD BLVD
WILSON NC
27893-1756
US

IV. Provider business mailing address

2700 WARD BLVD
WILSON NC
27893-1756
US

V. Phone/Fax

Practice location:
  • Phone: 252-640-6928
  • Fax: 252-640-6933
Mailing address:
  • Phone: 252-640-6928
  • Fax: 252-640-6933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: