Provider Demographics
NPI:1316541279
Name:OBADIKE, UDOKA
Entity Type:Individual
Prefix:
First Name:UDOKA
Middle Name:
Last Name:OBADIKE
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 1:44260 MONROE ST APT 32
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3062
Mailing Address - Country:US
Mailing Address - Phone:909-938-7479
Mailing Address - Fax:
Practice Address - Street 1:31575 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3138
Practice Address - Country:US
Practice Address - Phone:760-324-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist