MEDICARE: BRIDGET FABUSUYI

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
1	183500000X	Pharmacist	45574	TX

General Provider Information

NPI Number	:	1528398302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET FABUSUYI

Provider Business Mailing Address
First Line	:	18234 BONHAM OAKS CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2298
Country	:	US
Telephone Number	:	832-372-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3403 MANGUM RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-7415
Country	:	US
Telephone Number	:	713-683-8125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2009
Last Update Date	:	12/30/2009

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Directions to “ BRIDGET FABUSUYI ” Practice Location

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