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NPI Code Detail

MEDICARE: DR. NICOLE OMOTUNDE ETTI PHARM.D

MEDICARE: DR. NICOLE OMOTUNDE ETTI PHARM.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist47686TX

General Provider Information

NPI Number : 1194054957
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE OMOTUNDE ETTI PHARM.D
Provider Business Mailing Address
First Line : 9200 CULLEN BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77051-3317
Country : US
Telephone Number : 713-733-2406
Fax Number : 713-733-1692
Provider Business Practice Location Address
First Line : 9200 CULLEN BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77051-3317
Country : US
Telephone Number : 713-733-2406
Fax Number : 713-733-1692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2009
Last Update Date : 12/08/2009

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