Healthcare Provider Details

I. General information

NPI: 1770116378
Provider Name (Legal Business Name): JUDE OGBU-EZE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

IV. Provider business mailing address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-3837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number53765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: