Provider Demographics
NPI:1376182634
Name:ONWUBUYA-SAMUEL, JOAN K
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:K
Last Name:ONWUBUYA-SAMUEL
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 1:4980 E SILVER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3268
Mailing Address - Country:US
Mailing Address - Phone:352-236-1411
Mailing Address - Fax:352-236-1759
Practice Address - Street 1:4980 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-3268
Practice Address - Country:US
Practice Address - Phone:352-236-1411
Practice Address - Fax:352-236-1759
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist