Basic Information
Provider Information | |||||||||
NPI: | 1619534260 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OBIKA | ||||||||
FirstName: | ADAOBI | ||||||||
MiddleName: | STELLA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | OBIKA | ||||||||
OtherFirstName: | ADAOBI | ||||||||
OtherMiddleName: | STELLA | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ADAOBI STELLA OBIKA | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1703 GRAYSCROFT DR | ||||||||
Address2: |   | ||||||||
City: | WAXHAW | ||||||||
State: | NC | ||||||||
PostalCode: | 281736678 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7046516690 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | HIGHWAY 18 | ||||||||
Address2: |   | ||||||||
City: | PINE RIDGE | ||||||||
State: | SD | ||||||||
PostalCode: | 57770 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6058673192 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/20/2019 | ||||||||
LastUpdateDate: | 06/11/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 28000 | NC | Y |   | Pharmacy Service Providers | Pharmacist |   |
ID Information
ID | Type | State | Issuer | Description | 28000 | 01 | NC | PHARMACIST LICENSE | OTHER |