=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194523639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KINGSLEY CHIGOZIE OFODUM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 418 US HIGHWAY 22 W
-----------------------------------------------------
City | WHITEHOUSE STATION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08889-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-691-9199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 BERMUDA DR
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08853-4283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-930-2516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI04422700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------