Provider Demographics
NPI:1861614166
Name:OBI, EMMANUEL CHUKS SR (RPH)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:CHUKS
Last Name:OBI
Suffix:SR
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 1:5301 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-542-3880
Mailing Address - Fax:915-772-4844
Practice Address - Street 1:5301 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-542-3880
Practice Address - Fax:915-772-4844
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144857OtherTX MEDICAID VENDOR #
TX27510OtherTX PHARMACY LIC NUMBER
TX27510OtherTX PHARMACY LIC NUMBER
TX27510OtherTX PHARMACY LIC NUMBER