Active NPI
Theodore C Obialo, RPH
- Pharmacist
- Tyler, TX
National Provider Identifier
1053630012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 33412
- Practice address
- 3820 State Highway 64 W
Tyler, TX 75704-6924 - Phone
- (903) 597-3888
- NPI assigned
- May 28, 2010
- Last updated
- Oct 8, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 33412 | TX | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 33412 | TX |
Addresses
Primary practice location
3820 State Highway 64 W
Tyler, TX 75704-6924
Mailing address
3820 State Highway 64 W
Tyler, TX 75704-6924
Phone (903) 597-3888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33412 | Other | TX | PHARMACIST LICENCE |
Other names 1
- Mr. Ted Obialo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33412 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444262400000",
"number": "1053630012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3820 STATE HIGHWAY 64 W",
"city": "TYLER",
"state": "TX",
"postal_code": "757046924",
"telephone_number": "903-597-3888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3820 STATE HIGHWAY 64 W",
"city": "TYLER",
"state": "TX",
"postal_code": "757046924",
"telephone_number": "903-597-3888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBIALO",
"first_name": "THEODORE",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-28",
"last_updated": "2015-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "33412",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "TX",
"license": "33412",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENCE",
"identifier": "33412",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TED",
"last_name": "OBIALO",
"prefix": "MR.",
"credential": "RPH",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Tyler, TX
- Bella S Obach, PT
- Nichelle Obbin
- Jamie Obeso
- Peter Daniel Obesso, D.O.
- Ross Obiagwu
- Agnes Edith Owuor Obita-Ounda, M.D
- Occupational Health Centers of the Southwest P.a. (Concentra Medical Center)
- Occupational Health Centers of the Southwest P.a. (Concentra Medical Centers)
- Occupational Health Centers of the Southwest P.a. (Concentra Medical Centers)
- Dialezmy Ochoa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.