Provider Demographics
NPI:1801442496
Name:OGBODU, BRANDON NNAMDI (BRANDON)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:NNAMDI
Last Name:OGBODU
Suffix:
Gender:M
Credentials:BRANDON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 WOODLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3565
Mailing Address - Country:US
Mailing Address - Phone:818-606-3933
Mailing Address - Fax:
Practice Address - Street 1:9315 DELICADO DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-6207
Practice Address - Country:US
Practice Address - Phone:818-606-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65299OtherREGISTERED PHARMACIST