Provider Demographics
NPI:1245513431
Name:GBENJO, AMOS O (RPH)
Entity type:Individual
Prefix:MR
First Name:AMOS
Middle Name:O
Last Name:GBENJO
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 1:12405 N GESSNER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1170
Mailing Address - Country:US
Mailing Address - Phone:832-912-2352
Mailing Address - Fax:832-912-2373
Practice Address - Street 1:12405 N GESSNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1170
Practice Address - Country:US
Practice Address - Phone:832-912-2353
Practice Address - Fax:832-912-2373
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist