Provider Demographics
NPI:1558963421
Name:CHUKWUEMEKA-OGBA, MAKUACHUKWU (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAKUACHUKWU
Middle Name:
Last Name:CHUKWUEMEKA-OGBA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 SPADE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2212
Mailing Address - Country:US
Mailing Address - Phone:713-835-2312
Mailing Address - Fax:
Practice Address - Street 1:801 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4018
Practice Address - Country:US
Practice Address - Phone:432-943-4212
Practice Address - Fax:432-943-7503
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist