Essien Ebongo
Individual provider Active NPI Pharmacist · Dania, FL
NPI 1316222003 · NPPES record last updated Oct 13, 2011
Key facts
- NPI
- 1316222003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 40406 (FL)
- Practice address
- 202 S Federal Hwy
Dania, FL 33004-4005 - Phone
- (954) 920-0477
- NPI assigned
- Oct 13, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| 40406 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 40406 | FL | Yes |
Addresses
Primary practice location
202 S Federal Hwy
Dania, FL 33004-4005
Mailing address
202 S Federal Hwy
Dania, FL 33004-4005
Other providers in Dania, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2011. 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.