Provider Demographics
NPI:1992262364
Name:OSOSANYA, NGOZIKA GEORGIA
Entity type:Individual
Prefix:MS
First Name:NGOZIKA
Middle Name:GEORGIA
Last Name:OSOSANYA
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 1:8400 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4001
Mailing Address - Country:US
Mailing Address - Phone:405-996-6365
Mailing Address - Fax:405-513-5971
Practice Address - Street 1:1147A W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3008
Practice Address - Country:US
Practice Address - Phone:405-509-2469
Practice Address - Fax:405-513-5971
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist