Healthcare Provider Details

I. General information

NPI: 1427795137
Provider Name (Legal Business Name): OGBONNAYA OGBONNAYA PHARMD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/14/2022
Certification Date: 05/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 QUEENS WAY APT 1D
MILTON WA
98354-9052
US

IV. Provider business mailing address

2823 QUEENS WAY APT 1D
MILTON WA
98354-9052
US

V. Phone/Fax

Practice location:
  • Phone: 347-440-9087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61195316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: