MEDICARE: MR. EMMANUEL AZU OMEHE BACHELOR OF PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	34652	TX

General Provider Information

NPI Number	:	1093929507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EMMANUEL AZU OMEHE BACHELOR OF PHARMACY

Provider Business Mailing Address
First Line	:	2636 W WALNUT ST
Second Line	:	STE 300
City	:	GARLAND
State	:	TX
Zip	:	75042-6441
Country	:	US
Telephone Number	:	214-703-9000
Fax Number	:	214-703-9001

Provider Business Practice Location Address
First Line	:	2636 W WALNUT ST
Second Line	:	STE 300
City	:	GARLAND
State	:	TX
Zip	:	75042-6441
Country	:	US
Telephone Number	:	214-703-9000
Fax Number	:	214-703-9001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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