Provider Demographics
NPI:1649584111
Name:ADEMOLA, CATHERINE FAVOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:FAVOR
Last Name:ADEMOLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:FAVOR
Other - Last Name:SAMUEL NKWANCHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3990 E LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-5513
Mailing Address - Country:US
Mailing Address - Phone:409-898-2990
Mailing Address - Fax:
Practice Address - Street 1:1944 S. SEGUIN AVE (WALGREENS)
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-620-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist