Provider Demographics
NPI:1710600598
Name:IMOOBE, UNUIGBE BENARD
Entity Type:Individual
Prefix:
First Name:UNUIGBE
Middle Name:BENARD
Last Name:IMOOBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BON AIR DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8801
Mailing Address - Country:US
Mailing Address - Phone:856-343-2060
Mailing Address - Fax:
Practice Address - Street 1:137 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2378
Practice Address - Country:US
Practice Address - Phone:609-654-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03193500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist