Healthcare Provider Details

I. General information

NPI: 1255804688
Provider Name (Legal Business Name): DANIEL OGBEFHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 LINCOLN WAY E
FAYETTEVILLE PA
17222-1045
US

IV. Provider business mailing address

43850 TIMBER SQ UNIT 208
LEESBURG VA
20176-3457
US

V. Phone/Fax

Practice location:
  • Phone: 717-352-3850
  • Fax:
Mailing address:
  • Phone: 571-279-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453106
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: