Healthcare Provider Details

I. General information

NPI: 1487942843
Provider Name (Legal Business Name): UVO TEBANOSI OGHREIKANONE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DRIVE MCHE-QD
FPO AE
78234-6200
US

IV. Provider business mailing address

3851 ROGER BROOKE DRIVE MCHE-QD
APO AA
78234-6200
US

V. Phone/Fax

Practice location:
  • Phone: 210-295-9967
  • Fax:
Mailing address:
  • Phone: 210-295-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051291779
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2005017360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: