MEDICARE: DR. BISOLA MOSIDAT OGUNBANWO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	56013	TX

General Provider Information

NPI Number	:	1083331540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BISOLA MOSIDAT OGUNBANWO

Provider Business Mailing Address
First Line	:	4451 W FUQUA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6205
Country	:	US
Telephone Number	:	713-433-6447
Fax Number	:

Provider Business Practice Location Address
First Line	:	4451 W FUQUA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6205
Country	:	US
Telephone Number	:	713-433-6447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	10/25/2022

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