Provider Demographics
NPI:1174712053
Name:EZEANYA, ONYEMA A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ONYEMA
Middle Name:A
Last Name:EZEANYA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KENSINGTON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3889
Mailing Address - Country:US
Mailing Address - Phone:850-528-4413
Mailing Address - Fax:941-729-2123
Practice Address - Street 1:575 10TH ST E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4013
Practice Address - Country:US
Practice Address - Phone:941-729-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS393231835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support