Provider Demographics
NPI:1942024906
Name:AGUEBOR, GBENGA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GBENGA
Middle Name:
Last Name:AGUEBOR
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 1:7960 PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2454
Mailing Address - Country:US
Mailing Address - Phone:954-536-8145
Mailing Address - Fax:
Practice Address - Street 1:16550 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3646
Practice Address - Country:US
Practice Address - Phone:305-940-6172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist