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General NPI Number Information
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NPI Number | 1356859102
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Entity Type | Individual
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Provider Name | GIDEON AMOFA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 5997 S POINTE BLVD # 106
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City | FORT MYERS
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State | FL
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Zip | 33919-3272
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Country | US
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Telephone | 239-415-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 5610 SIX MILE COMMERCIAL CT APT 206
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City | FORT MYERS
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State | FL
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Zip | 33912-4528
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Country | US
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Telephone | 224-678-4919
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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 | PS56674
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License Number State | FL
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