Provider Demographics
NPI:1831794387
Name:FOHTUNG BILOLA EPSE GANA, FAITHFUL (B PHARM)
Entity type:Individual
Prefix:
First Name:FAITHFUL
Middle Name:
Last Name:FOHTUNG BILOLA EPSE GANA
Suffix:
Gender:F
Credentials:B PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 FM 1464 RD STE D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-6400
Mailing Address - Country:US
Mailing Address - Phone:832-886-4526
Mailing Address - Fax:
Practice Address - Street 1:7120 FM 1464 RD STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-6400
Practice Address - Country:US
Practice Address - Phone:832-886-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist