Provider Demographics
NPI:1801550165
Name:OBIDIKE, OBINNA REGINALD (RPH)
Entity type:Individual
Prefix:MR
First Name:OBINNA
Middle Name:REGINALD
Last Name:OBIDIKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15149 SHELLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6493
Mailing Address - Country:US
Mailing Address - Phone:201-932-6308
Mailing Address - Fax:
Practice Address - Street 1:7255 COIT RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4906
Practice Address - Country:US
Practice Address - Phone:214-705-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist