Provider Demographics
NPI:1013518380
Name:OFFOEGBU, KENNEDY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:
Last Name:OFFOEGBU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 SEGOVIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6321
Mailing Address - Country:US
Mailing Address - Phone:213-804-1110
Mailing Address - Fax:
Practice Address - Street 1:1515 S ELLISON DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1519
Practice Address - Country:US
Practice Address - Phone:210-276-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist