Provider Demographics
NPI:1699050393
Name:ONI, OLUGBENGA (RPH)
Entity type:Individual
Prefix:
First Name:OLUGBENGA
Middle Name:
Last Name:ONI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-610-3114
Mailing Address - Fax:321-622-8609
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:SUITE 126
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-610-3114
Practice Address - Fax:321-622-8609
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist