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General NPI Number Information
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NPI Number | 1235737792
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Entity Type | Individual
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Provider Name | MIKE OBENG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 5960 CASTLEWAY WEST DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-1977
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Country | US
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Telephone | 574-383-9206
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Fax |
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Provider Business Mailing Address
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Address Line | 5725 CHENSFORD DR APT 2C
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1251
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Country | US
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Telephone | 574-383-9206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 26027298A
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License Number State | IN
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