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NPI Code Detail

MEDICARE: SANDRA EGBEZIEMI OBAFUOSO

MEDICARE: SANDRA EGBEZIEMI OBAFUOSO
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
1183500000XPharmacist28RI03897800NJ

General Provider Information

NPI Number : 1912759721
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA EGBEZIEMI OBAFUOSO
Provider Business Mailing Address
First Line : 485 IRVINE TURNER BLVD FL 1
Second Line :
City : NEWARK
State : NJ
Zip : 07108-2415
Country : US
Telephone Number : 973-280-9673
Fax Number :
Provider Business Practice Location Address
First Line : 362 MONROE ST
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-4114
Country : US
Telephone Number : 862-249-1367
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2024
Last Update Date : 07/15/2024

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Directions to “ SANDRA EGBEZIEMI OBAFUOSO ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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