Provider Demographics
NPI:1679782999
Name:OBUSEH, SONY ANDREW
Entity type:Individual
Prefix:
First Name:SONY
Middle Name:ANDREW
Last Name:OBUSEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 WHEATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173
Mailing Address - Country:US
Mailing Address - Phone:704-243-1202
Mailing Address - Fax:
Practice Address - Street 1:3345 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-9304
Practice Address - Country:US
Practice Address - Phone:704-543-6055
Practice Address - Fax:704-544-9997
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist