Provider Demographics
NPI:1356859102
Name:AMOFA, GIDEON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GIDEON
Middle Name:
Last Name:AMOFA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 SIX MILE COMMERCIAL CT APT 206
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4528
Mailing Address - Country:US
Mailing Address - Phone:224-678-4919
Mailing Address - Fax:
Practice Address - Street 1:5997 S POINTE BLVD # 106
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3272
Practice Address - Country:US
Practice Address - Phone:239-415-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist