Provider Demographics
NPI:1831476449
Name:AWA-GABRIEL, CHIOMA
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:
Last Name:AWA-GABRIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHIOMA
Other - Middle Name:
Other - Last Name:OGUNSEKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 WEST RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 WEST RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1131
Practice Address - Country:US
Practice Address - Phone:281-445-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX043144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist