Provider Demographics
NPI:1740319524
Name:EMMANUEL CHUKS OBI
Entity type:Organization
Organization Name:EMMANUEL CHUKS OBI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-543-3880
Mailing Address - Street 1:5301 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5340 EL PASO DR
Practice Address - Street 2:STE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2837
Practice Address - Country:US
Practice Address - Phone:915-778-9900
Practice Address - Fax:915-778-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX224783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4573007OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145256Medicaid