Healthcare Provider Details

I. General information

NPI: 1801442496
Provider Name (Legal Business Name): BRANDON NNAMDI OGBODU BRANDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2019
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 DELICADO DR
HUMBLE TX
77396-6207
US

IV. Provider business mailing address

8221 WOODLAKE AVE
WEST HILLS CA
91304-3565
US

V. Phone/Fax

Practice location:
  • Phone: 818-606-3933
  • Fax:
Mailing address:
  • Phone: 818-606-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65299
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: