Provider Demographics
NPI:1508353301
Name:ANUMBOSI, JULIUS ASOFAR
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:ASOFAR
Last Name:ANUMBOSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JULIUS
Other - Middle Name:
Other - Last Name:ASOFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:PERIDOT
Mailing Address - State:AZ
Mailing Address - Zip Code:85542-0442
Mailing Address - Country:US
Mailing Address - Phone:240-520-2534
Mailing Address - Fax:
Practice Address - Street 1:103 MEDICINE WAY RD
Practice Address - Street 2:
Practice Address - City:PERIDOT
Practice Address - State:AZ
Practice Address - Zip Code:85542
Practice Address - Country:US
Practice Address - Phone:928-475-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0004888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist