Provider Demographics
NPI:1245583723
Name:TREASURE PHARMACY
Entity Type:Organization
Organization Name:TREASURE PHARMACY
Other - Org Name:TREASURE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONONOGBU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:817-617-3598
Mailing Address - Street 1:2625 MATLOCK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2527
Mailing Address - Country:US
Mailing Address - Phone:817-617-3598
Mailing Address - Fax:817-617-3619
Practice Address - Street 1:2625 MATLOCK RD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2527
Practice Address - Country:US
Practice Address - Phone:817-617-3598
Practice Address - Fax:817-617-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-20
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146680Medicaid