Provider Demographics
NPI:1447902994
Name:OFOLETA, ACHINIKE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ACHINIKE
Middle Name:
Last Name:OFOLETA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22418 SW 94TH PATH
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1263
Mailing Address - Country:US
Mailing Address - Phone:786-326-8058
Mailing Address - Fax:
Practice Address - Street 1:10650 NW 29TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2195
Practice Address - Country:US
Practice Address - Phone:305-262-7004
Practice Address - Fax:305-262-7006
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS24628OtherPHARMACIST LICENSE