Provider Demographics
NPI:1538469028
Name:FOSUYI ENTERPRISE
Entity Type:Organization
Organization Name:FOSUYI ENTERPRISE
Other - Org Name:RITE-MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-353-7223
Mailing Address - Street 1:2595 WATERMILL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-1621
Mailing Address - Country:US
Mailing Address - Phone:904-505-9720
Mailing Address - Fax:904-693-6684
Practice Address - Street 1:5312 N PEARL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5119
Practice Address - Country:US
Practice Address - Phone:904-353-7223
Practice Address - Fax:904-353-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-30
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH250063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5702382OtherNCPDP PROVIDER IDENTIFICATION NUMBER