Healthcare Provider Details

I. General information

NPI: 1689950628
Provider Name (Legal Business Name): OBED M NYARENCHI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 E MAIN ST
PLAINFIELD IN
46168-1791
US

IV. Provider business mailing address

5420 LONGWOODS DR
INDIANAPOLIS IN
46254-4248
US

V. Phone/Fax

Practice location:
  • Phone: 317-838-9187
  • Fax:
Mailing address:
  • Phone: 713-885-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26023844A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: