Healthcare Provider Details

I. General information

NPI: 1245513431
Provider Name (Legal Business Name): AMOS O GBENJO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12405 N GESSNER DR
HOUSTON TX
77064-1170
US

IV. Provider business mailing address

12405 N GESSNER DR
HOUSTON TX
77064-1170
US

V. Phone/Fax

Practice location:
  • Phone: 832-912-2353
  • Fax: 832-912-2373
Mailing address:
  • Phone: 832-912-2352
  • Fax: 832-912-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: