MEDICARE: DR. CHINONSO OLUEBUBE AGBASI 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	183500000X	Pharmacist	59539	TX

General Provider Information

NPI Number	:	1851902480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINONSO OLUEBUBE AGBASI PHARM.D

Provider Business Mailing Address
First Line	:	8310 DAWNRIDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-3835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8310 DAWNRIDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-3835
Country	:	US
Telephone Number	:	302-353-6813
Fax Number	:

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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