Provider Demographics
NPI:1689279549
Name:OLUWO, SEUN RAPHEAL (RPH)
Entity Type:Individual
Prefix:
First Name:SEUN
Middle Name:RAPHEAL
Last Name:OLUWO
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 1:4451 W FUQUA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-6205
Mailing Address - Country:US
Mailing Address - Phone:713-433-6447
Mailing Address - Fax:713-434-7832
Practice Address - Street 1:4451 W FUQUA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-6205
Practice Address - Country:US
Practice Address - Phone:713-433-6447
Practice Address - Fax:713-434-7832
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist