Provider Demographics
NPI:1194008045
Name:OWUSU-OFORI, FREDERICK (RPH)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:OWUSU-OFORI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 PEACEFUL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8916
Mailing Address - Country:US
Mailing Address - Phone:352-243-8511
Mailing Address - Fax:
Practice Address - Street 1:4400 S HWY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5383
Practice Address - Country:US
Practice Address - Phone:352-394-8029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist