Provider Demographics
NPI:1750795308
Name:AIFUWA, OGHOGHO
Entity type:Individual
Prefix:
First Name:OGHOGHO
Middle Name:
Last Name:AIFUWA
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 1:6817 GERMANTOWN AVE
Mailing Address - Street 2:APT 2R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2124
Mailing Address - Country:US
Mailing Address - Phone:732-586-7960
Mailing Address - Fax:
Practice Address - Street 1:640 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2031
Practice Address - Country:US
Practice Address - Phone:610-664-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444889183500000X
NJ28RI03400200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist