Healthcare Provider Details

I. General information

NPI: 1538084603
Provider Name (Legal Business Name): LYNDA OLUEBUBE OGBUJI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S 9TH AVE
WALLA WALLA WA
99362-3906
US

IV. Provider business mailing address

710 S 9TH AVE
WALLA WALLA WA
99362-3906
US

V. Phone/Fax

Practice location:
  • Phone: 509-516-4211
  • Fax:
Mailing address:
  • Phone: 509-516-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70015565
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: