Sandra Egbeziemi Obafuoso

Primary specialty

PharmacistTaxonomy code 183500000X

License

28RI03897800 Issued in NJ

Practice address

362 Monroe St
Passaic, NJ 07055-4114

Phone

(862) 249-1367

NPI assigned

Apr 4, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1912759721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 IRVINE TURNER BLVD FL 1",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071082415",
            "telephone_number": "973-280-9673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 MONROE ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554114",
            "telephone_number": "862-249-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBAFUOSO",
        "first_name": "SANDRA",
        "middle_name": "EGBEZIEMI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI03897800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nova Medical Enterprises Limited Liability Company
• Nova Medical Group LLC
• Ian James Nutkis, BCBA
• Nutrition RS LLC
• Rebecca O'Sullivan, BCBA
• John Obrien, RN
• Janet A Odondi, MD
• Hannah Ogrisek, LCSW
• Samuel Okechukwu
• Maksud Oliva, DPM

• Pharmacist in Passaic, NJ
• Providers in Passaic, NJ by specialty
• Pharmacist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.