Ebenezer Adu, PHARMACIST
Individual provider Active NPI Pharmacist · Lake City, FL
NPI 1124518659 · NPPES record last updated May 10, 2018
Key facts
- NPI
- 1124518659
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS44378 (FL)
- Practice address
- 2233 W US Highway 90
Lake City, FL 32055-4761 - Phone
- (352) 235-5310
- NPI assigned
- May 10, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS44378 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS44378 | FL | Yes |
Addresses
Primary practice location
2233 W US Highway 90
Lake City, FL 32055-4761
Mailing address
2233 W US Highway 90
Lake City, FL 32055-4761
Phone (352) 235-5310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS44378 | Other | FL | FLORIDA BOARD OF PHARMACY |
Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.