Provider Demographics
NPI:1609875541
Name:EMMANUEL CHUKS OBI
Entity Type:Organization
Organization Name:EMMANUEL CHUKS OBI
Other - Org Name:GOOD SHEPARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:915-542-3880
Mailing Address - Street 1:5301 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2805
Mailing Address - Country:US
Mailing Address - Phone:915-542-3880
Mailing Address - Fax:915-772-4844
Practice Address - Street 1:5301 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2805
Practice Address - Country:US
Practice Address - Phone:915-542-3880
Practice Address - Fax:915-772-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX196213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4509216OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX144857Medicaid
TX27510Medicaid