Healthcare Provider Details

I. General information

NPI: 1215397575
Provider Name (Legal Business Name): MICHAEL OGBONNA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N ABE ST
SAN ANGELO TX
76903-6361
US

IV. Provider business mailing address

7101 APPALOOSA TRL APT 223
SAN ANGELO TX
76901-5243
US

V. Phone/Fax

Practice location:
  • Phone: 325-658-3064
  • Fax:
Mailing address:
  • Phone: 718-300-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57651
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: