Provider Demographics
NPI:1013207398
Name:OMBOGO, JULIUS (RPH)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:OMBOGO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2391
Mailing Address - Country:US
Mailing Address - Phone:559-587-9626
Mailing Address - Fax:559-587-9537
Practice Address - Street 1:2500 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2391
Practice Address - Country:US
Practice Address - Phone:559-587-9626
Practice Address - Fax:559-587-9537
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 60365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist