Healthcare Provider Details

I. General information

NPI: 1629196662
Provider Name (Legal Business Name): PRINCE CHIMEZIE OGBONNA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 S HULEN ST STE 320
FORT WORTH TX
76132-2634
US

IV. Provider business mailing address

6080 S HULEN ST STE 320
FORT WORTH TX
76132-2634
US

V. Phone/Fax

Practice location:
  • Phone: 682-250-2229
  • Fax: 682-224-3820
Mailing address:
  • Phone: 682-250-2229
  • Fax: 682-224-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR4609
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH22660
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52139
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: