Provider Demographics
NPI:1902345580
Name:ENONJANG, KINGSLEY ENOHEBOB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KINGSLEY
Middle Name:ENOHEBOB
Last Name:ENONJANG
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 1:8004 MATINVESI ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8497
Mailing Address - Country:US
Mailing Address - Phone:832-264-9916
Mailing Address - Fax:
Practice Address - Street 1:1144 TOMMYS RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7978
Practice Address - Country:US
Practice Address - Phone:919-988-6038
Practice Address - Fax:919-988-6039
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229991835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22999OtherPHARMACIST LICENSE NUMBER