Provider Demographics
NPI:1033731385
Name:OBI, OGECHI SOPHIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OGECHI
Middle Name:SOPHIA
Last Name:OBI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MILL POND LN APT 401
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2146
Mailing Address - Country:US
Mailing Address - Phone:908-447-1298
Mailing Address - Fax:
Practice Address - Street 1:125 E NORTH POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2283
Practice Address - Country:US
Practice Address - Phone:410-572-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV27165OtherMARYLAND IMMUNIZER PROVIDER