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General NPI Number Information
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NPI Number | 1780040444
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Entity Type | Individual
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Provider Name | MODUPE OLATOKUNBO SOYOMBO PHARM D
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 4849 N HIGHWAY 146
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City | BAYTOWN
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State | TX
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Zip | 77520-8700
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Country | US
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Telephone | 281-420-9827
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Fax |
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Provider Business Mailing Address
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Address Line | 9955 BUFFALO SPEEDWAY APT 5204
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City | HOUSTON
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State | TX
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Zip | 77054-1325
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Country | US
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Telephone | 832-633-1979
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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 | 54663
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License Number State | TX
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