Provider Demographics
NPI:1366118234
Name:OFFIAH, NKIRUKA GENEVIEVE
Entity type:Individual
Prefix:
First Name:NKIRUKA
Middle Name:GENEVIEVE
Last Name:OFFIAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W 126TH ST APT 16G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2414
Mailing Address - Country:US
Mailing Address - Phone:310-654-1489
Mailing Address - Fax:
Practice Address - Street 1:120 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1210
Practice Address - Country:US
Practice Address - Phone:908-241-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04183100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist