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NPI Code Detail

MEDICARE: MIKE OBENG PHARMD

MEDICARE: MIKE OBENG PHARMD
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
13336C0002XClinic Pharmacy26027298AIN

General Provider Information

NPI Number : 1235737792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE OBENG PHARMD
Provider Business Mailing Address
First Line : 5725 CHENSFORD DR APT 2C
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46226-1251
Country : US
Telephone Number : 574-383-9206
Fax Number :
Provider Business Practice Location Address
First Line : 5960 CASTLEWAY WEST DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1977
Country : US
Telephone Number : 574-383-9206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2020
Last Update Date : 10/15/2020

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