Healthcare Provider Details

I. General information

NPI: 1346241684
Provider Name (Legal Business Name): GEOFFREY OGBOGU II PHARM.D., CDM.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILDWOOD CIR S 715
FORT WORTH TX
76132-5127
US

IV. Provider business mailing address

6404 WILDWOOD CIR S 715
FORT WORTH TX
76132-5127
US

V. Phone/Fax

Practice location:
  • Phone: 817-370-1624
  • Fax:
Mailing address:
  • Phone: 817-370-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42374
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number42374
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: