Provider Demographics
NPI:1922380021
Name:SANNI, BASHARAT ENEZE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BASHARAT
Middle Name:ENEZE
Last Name:SANNI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 PEELE ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3682
Mailing Address - Country:US
Mailing Address - Phone:704-232-1161
Mailing Address - Fax:
Practice Address - Street 1:440 E DIXIE DR
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6860
Practice Address - Country:US
Practice Address - Phone:336-625-2314
Practice Address - Fax:336-633-0007
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist