Provider Demographics
NPI:1194523639
Name:OFODUM, KINGSLEY CHIGOZIE
Entity type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:CHIGOZIE
Last Name:OFODUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-4283
Mailing Address - Country:US
Mailing Address - Phone:908-930-2516
Mailing Address - Fax:
Practice Address - Street 1:418 US HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3407
Practice Address - Country:US
Practice Address - Phone:908-691-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04422700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist