Provider Demographics
NPI:1609471135
Name:GBOGBARA INC
Entity Type:Organization
Organization Name:GBOGBARA INC
Other - Org Name:KING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LENYIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGBOGBARA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-331-8484
Mailing Address - Street 1:6202 GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15200 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1327
Practice Address - Country:US
Practice Address - Phone:313-821-4449
Practice Address - Fax:313-332-0317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GBOGBARA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy