Provider Demographics
NPI:1699003806
Name:OTEGBOLA, HELEN MODUPE (PHARM D)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:MODUPE
Last Name:OTEGBOLA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 W OREM DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-1253
Mailing Address - Country:US
Mailing Address - Phone:713-728-9406
Mailing Address - Fax:713-726-9410
Practice Address - Street 1:5501 W OREM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1253
Practice Address - Country:US
Practice Address - Phone:713-728-9406
Practice Address - Fax:713-726-9410
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist