Provider Demographics
NPI:1265751481
Name:ELOHIM PHARMACEUTICALS LLC
Entity type:Organization
Organization Name:ELOHIM PHARMACEUTICALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:P.I.C
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBEBAKU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-949-0228
Mailing Address - Street 1:8484 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3317
Mailing Address - Country:US
Mailing Address - Phone:210-949-0228
Mailing Address - Fax:210-949-0281
Practice Address - Street 1:8484 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3317
Practice Address - Country:US
Practice Address - Phone:210-949-0228
Practice Address - Fax:210-949-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26592333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146082Medicaid