Basic Information
| Provider Information | |||||||||
| NPI: | 1093929507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OMEHE | ||||||||
| FirstName: | EMMANUEL | ||||||||
| MiddleName: | AZU | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BACHELOR OF PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2636 W WALNUT ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750426441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147039000 | ||||||||
| FaxNumber: | 2147039001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2636 W WALNUT ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750426441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147039000 | ||||||||
| FaxNumber: | 2147039001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 34652 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.