Healthcare Provider Details

I. General information

NPI: 1558963421
Provider Name (Legal Business Name): MAKUA OGBA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 4TH ST
MONAHANS TX
79756-4018
US

IV. Provider business mailing address

801 E 4TH ST
MONAHANS TX
79756-4018
US

V. Phone/Fax

Practice location:
  • Phone: 432-943-4212
  • Fax: 432-943-7503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: