Active NPI
Hendreta Kinbong-Koffi, RPH
- Pharmacist
- Odessa, TX
National Provider Identifier
1376203893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 69874
- Practice address
- 100 E University Blvd
Odessa, TX 79762-7665 - Phone
- (432) 332-0908
- NPI assigned
- Dec 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 69874 | TX | Primary |
Addresses
Primary practice location
100 E University Blvd
Odessa, TX 79762-7665
Mailing address
100 E University Blvd
Odessa, TX 79762-7665
Phone (432) 332-0908
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 |
|---|---|---|---|
| 69874 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640217600000",
"number": "1376203893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E UNIVERSITY BLVD",
"city": "ODESSA",
"state": "TX",
"postal_code": "797627665",
"telephone_number": "432-332-0908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E UNIVERSITY BLVD",
"city": "ODESSA",
"state": "TX",
"postal_code": "797627665",
"telephone_number": "432-332-0908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINBONG-KOFFI",
"first_name": "HENDRETA",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-23",
"last_updated": "2021-12-23",
"certification_date": "2021-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "69874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.