Provider Demographics
NPI:1548605298
Name:MBOYA, ELVIS ESEMU
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:ESEMU
Last Name:MBOYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COTTON AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1421
Mailing Address - Country:US
Mailing Address - Phone:205-401-1897
Mailing Address - Fax:
Practice Address - Street 1:MCWHORTER SCHOOL OF PHARMACY
Practice Address - Street 2:800 LAKESHORE DR. HOMEWOOD
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35229-0001
Practice Address - Country:US
Practice Address - Phone:205-726-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10693183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician