Provider Demographics
NPI:1013786755
Name:OBILA, OLACHI GENES
Entity Type:Individual
Prefix:
First Name:OLACHI
Middle Name:GENES
Last Name:OBILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHI-CHI
Other - Middle Name:
Other - Last Name:OBILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:625 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3357
Mailing Address - Country:US
Mailing Address - Phone:857-247-0590
Mailing Address - Fax:
Practice Address - Street 1:625 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3357
Practice Address - Country:US
Practice Address - Phone:617-491-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTT21262183700000X
MAPT101571183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician