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General NPI Number Information
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NPI Number | 1144834524
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Entity Type | Individual
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Provider Name | NKIRUKA GLORIA OBI
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Gender | Female
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 501 HAVENDALE BLVD
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City | AUBURNDALE
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State | FL
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Zip | 33823-4629
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Country | US
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Telephone | 863-967-7518
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Fax |
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Provider Business Mailing Address
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Address Line | 5441 RIVER ROCK RD
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City | LAKELAND
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State | FL
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Zip | 33809-0962
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Country | US
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Telephone | 404-667-4030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS58895
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License Number State | FL
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