Provider Demographics
NPI:1558435479
Name:OBIANADIUME, VICTOR E (RPH)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:E
Last Name:OBIANADIUME
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21122 LAKE TALIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3737
Mailing Address - Country:US
Mailing Address - Phone:813-230-4212
Mailing Address - Fax:
Practice Address - Street 1:7747 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4715
Practice Address - Country:US
Practice Address - Phone:813-230-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0033246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH0033246OtherFLORIDA LICENSE NUMBER