Provider Demographics
NPI:1588068860
Name:CHB PHARMACY
Entity type:Organization
Organization Name:CHB PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EGBUCHUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:972-661-1293
Mailing Address - Street 1:14211 COIT RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2862
Mailing Address - Country:US
Mailing Address - Phone:972-661-1293
Mailing Address - Fax:972-661-1298
Practice Address - Street 1:14211 COIT RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2862
Practice Address - Country:US
Practice Address - Phone:972-661-1293
Practice Address - Fax:972-661-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29590OtherPHARMACY LICENSE