Provider Demographics
NPI:1912679598
Name:ITUAH, MARIA LAURA OTIBHO
Entity Type:Individual
Prefix:
First Name:MARIA LAURA
Middle Name:OTIBHO
Last Name:ITUAH
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 1:1313 FRY RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3343
Mailing Address - Country:US
Mailing Address - Phone:281-579-3373
Mailing Address - Fax:
Practice Address - Street 1:1313 FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3343
Practice Address - Country:US
Practice Address - Phone:281-579-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist