Healthcare Provider Details

I. General information

NPI: 1225543747
Provider Name (Legal Business Name): SEKINAT OLUBUKUNOLA KEKERE-EKUN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HIGHWAY 146 BYP
LIBERTY TX
77575-6000
US

IV. Provider business mailing address

2121 HIGHWAY 146 BYP
LIBERTY TX
77575-6000
US

V. Phone/Fax

Practice location:
  • Phone: 936-336-2257
  • Fax:
Mailing address:
  • Phone: 936-336-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48426
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: