Provider Demographics
NPI:1720657893
Name:OFOSU, ENOCH A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ENOCH
Middle Name:A
Last Name:OFOSU
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 1:1478 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3373
Mailing Address - Country:US
Mailing Address - Phone:863-537-6694
Mailing Address - Fax:863-537-6579
Practice Address - Street 1:1478 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3373
Practice Address - Country:US
Practice Address - Phone:863-537-6694
Practice Address - Fax:863-537-6579
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH354941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS35494OtherPHARMACY LICENSE
FL004112700Medicaid