Healthcare Provider Details

I. General information

NPI: 1760796031
Provider Name (Legal Business Name): TITILAYO OWOJORI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W FRANK AVE
LUFKIN TX
75904-3301
US

IV. Provider business mailing address

1000 W FRANK AVE
LUFKIN TX
75904-3301
US

V. Phone/Fax

Practice location:
  • Phone: 936-634-7083
  • Fax: 936-634-7091
Mailing address:
  • Phone: 936-634-7083
  • Fax: 936-634-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: