Healthcare Provider Details

I. General information

NPI: 1093366619
Provider Name (Legal Business Name): ABISOLA TAIRU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 03/08/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US-491
SHIPROCK NM
87420
US

IV. Provider business mailing address

2008 LANSHIRE DR
MCKINNEY TX
75072-2887
US

V. Phone/Fax

Practice location:
  • Phone: 505-356-7250
  • Fax:
Mailing address:
  • Phone: 469-358-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65714
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number65714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: