Provider Demographics
NPI:1386209765
Name:OGBODO, CHIZOBA T
Entity type:Individual
Prefix:MR
First Name:CHIZOBA
Middle Name:T
Last Name:OGBODO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CLUB CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1324
Mailing Address - Country:US
Mailing Address - Phone:916-928-6848
Mailing Address - Fax:916-928-0418
Practice Address - Street 1:2050 CLUB CENTER DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1324
Practice Address - Country:US
Practice Address - Phone:916-928-6848
Practice Address - Fax:916-928-0418
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist