Provider Demographics
NPI:1700490331
Name:NEBOH, STELLA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:NEBOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-2807
Mailing Address - Country:US
Mailing Address - Phone:432-337-6637
Mailing Address - Fax:432-337-1309
Practice Address - Street 1:801 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-2807
Practice Address - Country:US
Practice Address - Phone:432-337-6637
Practice Address - Fax:432-337-1309
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist