Provider Demographics
NPI:1659098093
Name:ADEGBENRO, ADETOKUNBOH (RPH)
Entity Type:Individual
Prefix:
First Name:ADETOKUNBOH
Middle Name:
Last Name:ADEGBENRO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MEYER ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3433
Mailing Address - Country:US
Mailing Address - Phone:979-885-3538
Mailing Address - Fax:979-885-3168
Practice Address - Street 1:802 MEYER ST
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3433
Practice Address - Country:US
Practice Address - Phone:979-885-3538
Practice Address - Fax:979-885-3168
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist