MEDICARE: DR. QUEEN OZIGBOH PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	010909	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010909	OTHER	TX	HCS AGENCY LICENSE

General Provider Information

NPI Number	:	1841323532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUEEN OZIGBOH PHARM.D.

Provider Business Mailing Address
First Line	:	2600 SOUTH LOOP W
Second Line	:	SUITE 435
City	:	HOUSTON
State	:	TX
Zip	:	77054-2653
Country	:	US
Telephone Number	:	713-667-2427
Fax Number	:	713-668-3180

Provider Business Practice Location Address
First Line	:	2600 SOUTH LOOP W
Second Line	:	SUITE 435
City	:	HOUSTON
State	:	TX
Zip	:	77054-2653
Country	:	US
Telephone Number	:	713-667-2427
Fax Number	:	713-668-3180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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