Provider Demographics
NPI:1649875568
Name:OWI, DOITE MOJISOLA JOY
Entity type:Individual
Prefix:
First Name:DOITE
Middle Name:MOJISOLA JOY
Last Name:OWI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MISCOE RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3517
Mailing Address - Country:US
Mailing Address - Phone:508-410-1259
Mailing Address - Fax:
Practice Address - Street 1:63 CANAL ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-3252
Practice Address - Country:US
Practice Address - Phone:508-865-8805
Practice Address - Fax:508-581-9526
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist