Provider Demographics
NPI:1629196662
Name:OGBONNA, PRINCE CHIMEZIE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PRINCE
Middle Name:CHIMEZIE
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 S HULEN ST STE 320
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2634
Mailing Address - Country:US
Mailing Address - Phone:682-250-2229
Mailing Address - Fax:682-224-3820
Practice Address - Street 1:6080 S HULEN ST STE 320
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2634
Practice Address - Country:US
Practice Address - Phone:682-250-2229
Practice Address - Fax:682-224-3820
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4609183500000X
MAPH22660183500000X
TX52139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX52139OtherTEXAS BOARD OF PHARMACY FOR PHARMACIST
GAPH22660OtherRPH LICENSE NUMBER
TX150302Medicaid
MEPR4609OtherRPH LICENSE NUMBER