Healthcare Provider Details

I. General information

NPI: 1619580339
Provider Name (Legal Business Name): LILIAN NDIDI OGBUEZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 W MILITARY DR
SAN ANTONIO TX
78251-3903
US

IV. Provider business mailing address

11103 W MILITARY DR
SAN ANTONIO TX
78251-3903
US

V. Phone/Fax

Practice location:
  • Phone: 210-679-5267
  • Fax: 210-679-0460
Mailing address:
  • Phone: 210-679-5267
  • Fax: 210-679-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: