Provider Demographics
NPI:1780979948
Name:AIGBEDION, BUKOLA OLOWOS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BUKOLA
Middle Name:OLOWOS
Last Name:AIGBEDION
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 1:818 RINGOLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-6368
Mailing Address - Country:US
Mailing Address - Phone:281-260-3443
Mailing Address - Fax:281-260-3335
Practice Address - Street 1:818 RINGOLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-6368
Practice Address - Country:US
Practice Address - Phone:281-260-3443
Practice Address - Fax:281-260-3335
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15427714Medicaid