=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255796819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. ANAYO THEODORA OGBONNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2015
-----------------------------------------------------
Last Update Date | 10/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 WARD BLVD
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27893-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-640-6928
-----------------------------------------------------
Fax | 252-640-6933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 WARD BLVD
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27893-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-640-6928
-----------------------------------------------------
Fax | 252-640-6933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 24486
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------