Provider Demographics
NPI:1215088778
Name:NKWONTA, OLIVER E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:E
Last Name:NKWONTA
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 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1636
Mailing Address - Country:US
Mailing Address - Phone:908-754-1600
Mailing Address - Fax:908-756-6270
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1636
Practice Address - Country:US
Practice Address - Phone:908-754-1600
Practice Address - Fax:908-756-6270
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02009300183500000X
NJ2009300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8546304Medicaid