Provider Demographics
NPI:1568866234
Name:TEXAS CHILDREN'S HOSPITAL PHARMACY-SOUTHWEST
Entity type:Organization
Organization Name:TEXAS CHILDREN'S HOSPITAL PHARMACY-SOUTHWEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:OLAYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUDU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA-HC
Authorized Official - Phone:832-824-5250
Mailing Address - Street 1:9700 BISSONNET ST STE 1000W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8001
Mailing Address - Country:US
Mailing Address - Phone:346-232-4960
Mailing Address - Fax:
Practice Address - Street 1:9700 BISSONNET ST STE 1000W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8001
Practice Address - Country:US
Practice Address - Phone:346-232-4960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29572261Q00000X
333600000X, 3336C0002X, 3336C0003X, 333600000X, 3336C0002X, 3336C0003X, 3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336C0002XSuppliersPharmacyClinic Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29572OtherTEXAS STATE BOARD OF PHARMACY