Healthcare Provider Details

I. General information

NPI: 1164967964
Provider Name (Legal Business Name): ADINOYI OMEIZA GARBA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PORTER AVE DAC 325 (PHARMACY PRACTICE SUITE)
BUFFALO NY
14201-1032
US

IV. Provider business mailing address

4333 CHESTNUT RIDGE RD APT 8
AMHERST NY
14228-3220
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-8496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number056295
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number056295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: