Healthcare Provider Details

I. General information

NPI: 1346844461
Provider Name (Legal Business Name): NKASIOBI OGBONNA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. NKASIOBI IFEADIKE

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 HAMPTON BLVD
NORFOLK VA
23508-2425
US

IV. Provider business mailing address

3717 HAMPTON BLVD
NORFOLK VA
23508-2425
US

V. Phone/Fax

Practice location:
  • Phone: 404-510-6792
  • Fax:
Mailing address:
  • Phone: 404-510-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219389
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH032257
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: