Provider Demographics
NPI:1568831733
Name:ENIGBOKAN, MOFOLORUNSO
Entity Type:Individual
Prefix:DR
First Name:MOFOLORUNSO
Middle Name:
Last Name:ENIGBOKAN
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 1:1150 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6208
Mailing Address - Country:US
Mailing Address - Phone:713-576-2052
Mailing Address - Fax:713-576-2071
Practice Address - Street 1:1150 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6208
Practice Address - Country:US
Practice Address - Phone:713-576-2052
Practice Address - Fax:713-576-2071
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist