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General NPI Number Information
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NPI Number | 1508467671
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Entity Type | Individual
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Provider Name | OLGA TANDE MEBOKA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 20310 US HIGHWAY 59
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City | NEW CANEY
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State | TX
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Zip | 77357-8266
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Country | US
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Telephone | 281-306-7099
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Fax |
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Provider Business Mailing Address
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Address Line | 14698 BRIAR FOREST DR APT 13201
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City | HOUSTON
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State | TX
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Zip | 77077-2629
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Country | US
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Telephone | 334-275-0557
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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 | 65624
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License Number State | TX
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