Provider Demographics
NPI:1003632340
Name:OGUNGBE, MOYOSORE A (RPH)
Entity type:Individual
Prefix:
First Name:MOYOSORE
Middle Name:A
Last Name:OGUNGBE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 CURRY FORD RD APT N205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7210
Mailing Address - Country:US
Mailing Address - Phone:407-419-7710
Mailing Address - Fax:
Practice Address - Street 1:12279 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5010
Practice Address - Country:US
Practice Address - Phone:407-273-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist