Healthcare Provider Details

I. General information

NPI: 1104668466
Provider Name (Legal Business Name): EZINNE QUEENTH OGBONNAYA PHARM.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 06/08/2024
Certification Date: 06/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 HARPOST MNR
SPRING TX
77379-8442
US

IV. Provider business mailing address

5611 HARPOST MNR
SPRING TX
77379-8442
US

V. Phone/Fax

Practice location:
  • Phone: 832-462-4284
  • Fax:
Mailing address:
  • Phone: 832-462-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number225420
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: