Healthcare Provider Details

I. General information

NPI: 1033714423
Provider Name (Legal Business Name): ITOHAN JENNIFER OGBEBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 SPRING HILL DR
SPRING TX
77386-6032
US

IV. Provider business mailing address

19103 ANGLER COVE DR
CYPRESS TX
77433-3079
US

V. Phone/Fax

Practice location:
  • Phone: 281-466-5804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48556
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: