Healthcare Provider Details

I. General information

NPI: 1023927589
Provider Name (Legal Business Name): DR. CHIOMA OLUMBA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 N MICHIGAN ST
PITTSBURG KS
66762-2546
US

IV. Provider business mailing address

1910 S PINE ST APT D222
PITTSBURG KS
66762-5743
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-9873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-127757
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: