Provider Demographics
NPI:1194594762
Name:GARBA, OSOMINOMO
Entity type:Individual
Prefix:
First Name:OSOMINOMO
Middle Name:
Last Name:GARBA
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 1:305 TOLLHOUSE PL APT 204H
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-9728
Mailing Address - Country:US
Mailing Address - Phone:301-455-5567
Mailing Address - Fax:
Practice Address - Street 1:800 CHRISTIANA MALL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3216
Practice Address - Country:US
Practice Address - Phone:302-668-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist