Healthcare Provider Details

I. General information

NPI: 1790067403
Provider Name (Legal Business Name): OMISHAN A OGHOLOH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N HIGHWAY 190
COVINGTON LA
70433-5157
US

IV. Provider business mailing address

9933 E WHEATON CIR
NEW ORLEANS LA
70127-2239
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-1515
  • Fax: 985-809-1514
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018663
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: