Provider Demographics
NPI:1891347225
Name:OBENG PHARMACY LLC
Entity Type:Organization
Organization Name:OBENG PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADJE
Authorized Official - Middle Name:DABY
Authorized Official - Last Name:KOFFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-237-7601
Mailing Address - Street 1:1 BRISTLECONE DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2818
Mailing Address - Country:US
Mailing Address - Phone:862-237-7601
Mailing Address - Fax:
Practice Address - Street 1:431-433 ELIZABETH AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:862-237-7601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy