Healthcare Provider Details

I. General information

NPI: 1548866338
Provider Name (Legal Business Name): EBITIMI FLORENCE OKOYA-WILCOX RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 ROUTE 9 N
OLD BRIDGE NJ
08857-2469
US

IV. Provider business mailing address

3 KING RICHARD CT
WATCHUNG NJ
07069-6151
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-3535
  • Fax: 732-727-3031
Mailing address:
  • Phone: 908-612-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01795000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: