Provider Demographics
NPI:1366044299
Name:ABHULIMEN, EVELYN OMOZUSI (DR)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:OMOZUSI
Last Name:ABHULIMEN
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TULIP DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2257
Mailing Address - Country:US
Mailing Address - Phone:501-246-0394
Mailing Address - Fax:
Practice Address - Street 1:133 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1963
Practice Address - Country:US
Practice Address - Phone:870-773-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist