Provider Demographics
NPI:1396213203
Name:AGBOZO, YESUTOR CHRISTABEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YESUTOR
Middle Name:CHRISTABEL
Last Name:AGBOZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 HADDEN HALL PL
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7270
Mailing Address - Country:US
Mailing Address - Phone:813-401-2199
Mailing Address - Fax:
Practice Address - Street 1:700 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-6101
Practice Address - Country:US
Practice Address - Phone:813-401-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist