Provider Demographics
NPI:1912411984
Name:BABALOLA, PHEBIAN ARINOLA
Entity Type:Individual
Prefix:
First Name:PHEBIAN
Middle Name:ARINOLA
Last Name:BABALOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E CARTWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6623
Mailing Address - Country:US
Mailing Address - Phone:972-222-3404
Mailing Address - Fax:972-222-2397
Practice Address - Street 1:751 W TUCSON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-7200
Practice Address - Country:US
Practice Address - Phone:918-455-0089
Practice Address - Fax:918-455-0024
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0012773183500000X
OK15836183500000X
TX54602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist