Healthcare Provider Details

I. General information

NPI: 1841574332
Provider Name (Legal Business Name): ENOVWO ELOHO OHWOFAHWORAYE PHARMD, DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 W HUNTER ST
LOGAN OH
43138-1013
US

IV. Provider business mailing address

1383 W HUNTER ST
LOGAN OH
43138-1013
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-0202
  • Fax:
Mailing address:
  • Phone: 740-385-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03226174
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.013090
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP2282058A49
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: