Healthcare Provider Details

I. General information

NPI: 1336444256
Provider Name (Legal Business Name): OBATARE AVWORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HARWIN DR STE 3
HOUSTON TX
77036-2793
US

IV. Provider business mailing address

10301 HARWIN DR STE 3
HOUSTON TX
77036-2793
US

V. Phone/Fax

Practice location:
  • Phone: 346-352-4930
  • Fax: 346-352-4959
Mailing address:
  • Phone: 346-352-4930
  • Fax: 346-352-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: OBATARE RICHARD AVWORO
Title or Position: OWNER / PHARMACIST IN CHARGE
Credential: RPH
Phone: 346-352-4930