Leli Omecham Stephen Agboire, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

64715 Issued in TX

Practice address

Walgreens
4415 North State Line Avenue
Texarkana, TX 75503

Phone

(903) 792-8918

NPI assigned

Jun 1, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1700525417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 ROSHARON DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751262450",
            "telephone_number": "469-605-8251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WALGREENS",
            "address_2": "4415 NORTH STATE LINE AVENUE",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "75503",
            "telephone_number": "903-792-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHEN AGBOIRE",
        "first_name": "LELI",
        "middle_name": "OMECHAM",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "64715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF PHARMACY",
            "identifier": "64715",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonya Prince Stark, FNP-C
• Callie Elizabeth Starks, M.S., LPC-I
• Stateserv Medical of Texas, LLC
• David Larkin Steele, DDS
• Stephen Lynn Steele, MD
• Stephen R. Brown, M.D., PA
• John O Stevens, MD
• Tiffaine Stevens, CHW
• Stephanie Ann Stewart
• Stolba Chiropractic Center P.C.

• Pharmacist in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.