Healthcare Provider Details

I. General information

NPI: 1700481652
Provider Name (Legal Business Name): PRISCILLA MMUTAKA NJOKU BPHARM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31013 FM 2920 RD
WALLER TX
77484-8008
US

IV. Provider business mailing address

31013 FM 2920 RD
WALLER TX
77484-8008
US

V. Phone/Fax

Practice location:
  • Phone: 936-372-9141
  • Fax: 936-372-5973
Mailing address:
  • Phone: 936-372-9141
  • Fax: 936-372-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: