Healthcare Provider Details

I. General information

NPI: 1205439510
Provider Name (Legal Business Name): DEBORAH OGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 CLIFFORD ST
FORT WORTH TX
76108-4403
US

IV. Provider business mailing address

4155 NAPOLI WAY
IRVING TX
75038-3400
US

V. Phone/Fax

Practice location:
  • Phone: 817-367-0818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: