Active NPI
Adje Daby Koffi
- Pharmacist
- Newark, NJ
National Provider Identifier
1619375995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03075400
- Practice address
- 671 Martin Luther King Blvd
Newark, NJ 07102 - Phone
- (862) 237-7601
- Fax
- (862) 237-7603
- NPI assigned
- Dec 18, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI03075400 | NJ | Primary |
Addresses
Primary practice location
671 Martin Luther King Blvd
Newark, NJ 07102
Mailing address
1 Bristlecone Drive
Howell, NJ 07731
Phone (215) 459-8390
Other practice location 1
1 Bristlecone Drive
Howell, NJ 07731
Phone (215) 459-8390
Other practice location 2
95 Broadway
Newark, NJ 07104-3875
Phone (973) 483-2323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03075400 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Obeng Pharmacy LLC | Past | Accepting new patients | |
| Obeng Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Newark, NJ
- NPI 1376052670
-
- Community/Retail Pharmacy
- Newark, NJ
- NPI 1538557178
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528070400000",
"number": "1619375995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BRISTLECONE DRIVE",
"city": "HOWELL",
"state": "NJ",
"postal_code": "07731",
"telephone_number": "215-459-8390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "671 MARTIN LUTHER KING BLVD",
"city": "NEWARK",
"state": "NJ",
"postal_code": "07102",
"telephone_number": "862-237-7601",
"fax_number": "862-237-7603"
}
],
"practiceLocations": [
{
"address_1": "1 Bristlecone Drive",
"address_purpose": "LOCATION",
"city": "Howell",
"state": "NJ",
"postal_code": "07731",
"country_code": "US",
"telephone_number": "215-459-8390",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "95 Broadway",
"address_purpose": "LOCATION",
"city": "Newark",
"state": "NJ",
"postal_code": "071043875",
"country_code": "US",
"telephone_number": "973-483-2323",
"fax_number": "973-483-2333",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOFFI",
"first_name": "ADJE",
"middle_name": "DABY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-18",
"last_updated": "2018-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03075400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.