Provider Demographics
NPI:1750159851
Name:OMOEGBELE, EHIMEN DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:EHIMEN
Middle Name:DOUGLAS
Last Name:OMOEGBELE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BEN SWAIN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-4109
Mailing Address - Country:US
Mailing Address - Phone:832-513-3513
Mailing Address - Fax:
Practice Address - Street 1:3100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1162
Practice Address - Country:US
Practice Address - Phone:575-525-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist