Healthcare Provider Details

I. General information

NPI: 1619563624
Provider Name (Legal Business Name): AZUKA OBUBA PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 ROUTE 22 WEST
HILLSIDE NJ
07205
US

IV. Provider business mailing address

82 ROANOKE RD
BELLE MEAD NJ
08502-5829
US

V. Phone/Fax

Practice location:
  • Phone: 908-810-8060
  • Fax:
Mailing address:
  • Phone: 732-986-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03110700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: