Provider Demographics
NPI:1346566528
Name:OBIEBI, EMAMOKE E (BPHARM)
Entity Type:Individual
Prefix:
First Name:EMAMOKE
Middle Name:E
Last Name:OBIEBI
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 AVIATOR CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1253
Mailing Address - Country:US
Mailing Address - Phone:916-928-9316
Mailing Address - Fax:
Practice Address - Street 1:6639 WATT AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-3607
Practice Address - Country:US
Practice Address - Phone:916-332-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist