Provider Demographics
NPI:1376052670
Name:OBENG PHARMACY LLC
Entity Type:Organization
Organization Name:OBENG PHARMACY LLC
Other - Org Name:OBENG PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADJE
Authorized Official - Middle Name:DABY
Authorized Official - Last Name:KOFFI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-459-8390
Mailing Address - Street 1:671 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1186
Mailing Address - Country:US
Mailing Address - Phone:215-459-8390
Mailing Address - Fax:
Practice Address - Street 1:95 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3875
Practice Address - Country:US
Practice Address - Phone:215-459-8390
Practice Address - Fax:862-237-7603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBENG PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy