Provider Demographics
NPI:1093929507
Name:OMEHE, EMMANUEL AZU (BACHELOR OF PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:AZU
Last Name:OMEHE
Suffix:
Gender:M
Credentials:BACHELOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 W WALNUT ST
Mailing Address - Street 2:STE 300
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6441
Mailing Address - Country:US
Mailing Address - Phone:214-703-9000
Mailing Address - Fax:214-703-9001
Practice Address - Street 1:2636 W WALNUT ST
Practice Address - Street 2:STE 300
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6441
Practice Address - Country:US
Practice Address - Phone:214-703-9000
Practice Address - Fax:214-703-9001
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist