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General NPI Number Information
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NPI Number | 1508148966
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Entity Type | Individual
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Provider Name | DR. AKINJIDE AGBODO
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Gender | Male
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 17119 FM 362 RD
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City | WALLER
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State | TX
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Zip | 77484-9317
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Country | US
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Telephone | 936-372-8044
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Fax |
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Provider Business Mailing Address
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Address Line | 17119 FM 362 RD
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City | WALLER
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State | TX
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Zip | 77484-9317
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Country | US
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Telephone | 832-745-9144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 56452
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License Number State | TX
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