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General NPI Number Information
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NPI Number | 1538469028
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Entity Type | Organization
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Legal Business Name | FOSUYI ENTERPRISE
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 5312 N PEARL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32208-5119
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Country | US
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Telephone | 904-353-7223
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Fax | 904-353-7224
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Provider Business Mailing Address
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Address Line | 2595 WATERMILL DR
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City | ORANGE PARK
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State | FL
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Zip | 32073-1621
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Country | US
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Telephone | 904-505-9720
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Fax | 904-693-6684
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | FELIX OBASUYI
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Credential |
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Telephone | 904-353-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25006
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License Number State | FL
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