Healthcare Provider Details

I. General information

NPI: 1861004061
Provider Name (Legal Business Name): STEPHANIE OGUNRINADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9522 BROADWAY ST
PEARLAND TX
77584-7724
US

IV. Provider business mailing address

3035 EMILY VISTA LN
FRESNO TX
77545-5205
US

V. Phone/Fax

Practice location:
  • Phone: 713-436-8151
  • Fax:
Mailing address:
  • Phone: 512-751-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56807
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: