Provider Demographics
NPI:1578164430
Name:ABUBAKAR, GAMBO EHIMEAKHE
Entity Type:Individual
Prefix:
First Name:GAMBO
Middle Name:EHIMEAKHE
Last Name:ABUBAKAR
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 1:2900 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3535
Mailing Address - Country:US
Mailing Address - Phone:972-283-1059
Mailing Address - Fax:
Practice Address - Street 1:2900 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3535
Practice Address - Country:US
Practice Address - Phone:972-283-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist