Provider Demographics
NPI:1093730848
Name:OGUH, CHIGOZIE GILBERT
Entity Type:Individual
Prefix:MR
First Name:CHIGOZIE
Middle Name:GILBERT
Last Name:OGUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 LA QUINTA PL STE 101
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5227
Mailing Address - Country:US
Mailing Address - Phone:915-593-0603
Mailing Address - Fax:915-593-3378
Practice Address - Street 1:11140 LA QUINTA PL STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5227
Practice Address - Country:US
Practice Address - Phone:915-593-0603
Practice Address - Fax:915-593-3378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28440183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149185Medicaid
TX22619OtherPHARMACY
TX166165402OtherMEDICARE
TX22619OtherPHARMACY