Provider Demographics
NPI:1134344203
Name:EPOH, AGBOMMA JULIET (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AGBOMMA
Middle Name:JULIET
Last Name:EPOH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22930 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-517-1851
Mailing Address - Fax:310-517-0368
Practice Address - Street 1:22930 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:310-517-1851
Practice Address - Fax:310-517-0368
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-12-27
Deactivation Date:2010-03-26
Deactivation Code:
Reactivation Date:2012-12-27
Provider Licenses
StateLicense IDTaxonomies
CA65127183700000X
CA67551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician