Provider Demographics
NPI:1568723708
Name:BUBU, ETHEL O (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:O
Last Name:BUBU
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:DR
Other - First Name:ETHEL
Other - Middle Name:O
Other - Last Name:OYEKUNLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD,RPH
Mailing Address - Street 1:2007 CROSBYTON LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8868
Mailing Address - Country:US
Mailing Address - Phone:502-418-7872
Mailing Address - Fax:214-235-0903
Practice Address - Street 1:2007 CROSBYTON LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8868
Practice Address - Country:US
Practice Address - Phone:502-418-7872
Practice Address - Fax:214-235-0903
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405851835P0018X
IN26020680A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist