Healthcare Provider Details

I. General information

NPI: 1255943742
Provider Name (Legal Business Name): TAIYE O OGUNMAKIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CENTRE CREEK DR STE 115
AUSTIN TX
78754-5133
US

IV. Provider business mailing address

2210 MID LN
HOUSTON TX
77027-3845
US

V. Phone/Fax

Practice location:
  • Phone: 512-579-0026
  • Fax:
Mailing address:
  • Phone: 713-884-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: