Healthcare Provider Details

I. General information

NPI: 1093730848
Provider Name (Legal Business Name): MR. CHIGOZIE GILBERT OGUH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 LA QUINTA PL STE 101
EL PASO TX
79936-5227
US

IV. Provider business mailing address

11140 LA QUINTA PL STE 101
EL PASO TX
79936-5227
US

V. Phone/Fax

Practice location:
  • Phone: 915-593-0603
  • Fax: 915-593-3378
Mailing address:
  • Phone: 915-593-0603
  • Fax: 915-593-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28440
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: