Provider Demographics
NPI:1366124646
Name:SOYEBO, OLUKEMI (PHARMD)
Entity type:Individual
Prefix:
First Name:OLUKEMI
Middle Name:
Last Name:SOYEBO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 SENDERA LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8512
Mailing Address - Country:US
Mailing Address - Phone:281-935-1715
Mailing Address - Fax:
Practice Address - Street 1:16281 IMPERIAL VALLEY DR STE J
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3582
Practice Address - Country:US
Practice Address - Phone:281-741-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist