Provider Demographics
NPI:1609282086
Name:DOUGLAS, OBUGO (RPH)
Entity Type:Individual
Prefix:DR
First Name:OBUGO
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23026 N WATERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-9612
Mailing Address - Country:US
Mailing Address - Phone:516-425-5550
Mailing Address - Fax:
Practice Address - Street 1:23026 N WATERLAKE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-9612
Practice Address - Country:US
Practice Address - Phone:516-425-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist