Provider Demographics
NPI:1225522824
Name:OSILAMA, EGHONGHON JOYCE
Entity Type:Individual
Prefix:
First Name:EGHONGHON
Middle Name:JOYCE
Last Name:OSILAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ALGONQUIN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3630
Mailing Address - Country:US
Mailing Address - Phone:781-363-4223
Mailing Address - Fax:
Practice Address - Street 1:1390 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5481
Practice Address - Country:US
Practice Address - Phone:603-430-7595
Practice Address - Fax:603-430-7746
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist