Provider Demographics
NPI:1437750569
Name:OBAZEE, EKI JENNIFER
Entity Type:Individual
Prefix:
First Name:EKI
Middle Name:JENNIFER
Last Name:OBAZEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6906
Mailing Address - Country:US
Mailing Address - Phone:214-388-5703
Mailing Address - Fax:214-388-5701
Practice Address - Street 1:2827 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6906
Practice Address - Country:US
Practice Address - Phone:214-388-5703
Practice Address - Fax:214-388-5701
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist