Provider Demographics
NPI:1487711792
Name:OBI PHARM INTERNATIONAL IMP & EXP INC
Entity type:Organization
Organization Name:OBI PHARM INTERNATIONAL IMP & EXP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:ATHANASIUS
Authorized Official - Last Name:CHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:313-341-6123
Mailing Address - Street 1:13701 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1714
Mailing Address - Country:US
Mailing Address - Phone:313-341-6123
Mailing Address - Fax:313-341-6124
Practice Address - Street 1:13701 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1714
Practice Address - Country:US
Practice Address - Phone:313-341-6123
Practice Address - Fax:313-341-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028708183500000X
MI53010065903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3361632Medicaid
MI3361632Medicaid