MEDICARE: DR. OSITA C EZENWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS33892	FL

General Provider Information

NPI Number	:	1750631859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSITA C EZENWA

Provider Business Mailing Address
First Line	:	6974 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023-2676
Country	:	US
Telephone Number	:	954-993-5066
Fax Number	:	866-572-2210

Provider Business Practice Location Address
First Line	:	6974 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023-2676
Country	:	US
Telephone Number	:	954-993-5066
Fax Number	:	866-572-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2012
Last Update Date	:	05/04/2026

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