Provider Demographics
NPI:1215397575
Name:OGBONNA, MICHAEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 APPALOOSA TRL
Mailing Address - Street 2:APT 223
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5243
Mailing Address - Country:US
Mailing Address - Phone:718-300-4886
Mailing Address - Fax:
Practice Address - Street 1:12 N ABE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6361
Practice Address - Country:US
Practice Address - Phone:325-658-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist