Provider Demographics
NPI:1720701220
Name:OFFONG, OBIO
Entity Type:Individual
Prefix:
First Name:OBIO
Middle Name:
Last Name:OFFONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-3512
Mailing Address - Country:US
Mailing Address - Phone:281-452-7184
Mailing Address - Fax:281-862-0631
Practice Address - Street 1:814 SHELDON RD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-3512
Practice Address - Country:US
Practice Address - Phone:281-452-7184
Practice Address - Fax:281-862-0631
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist