Provider Demographics
NPI:1598369753
Name:MPOFU, MTHETHUVUMILE
Entity type:Individual
Prefix:
First Name:MTHETHUVUMILE
Middle Name:
Last Name:MPOFU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7015
Mailing Address - Country:US
Mailing Address - Phone:832-373-3430
Mailing Address - Fax:
Practice Address - Street 1:117 OYSTER CREEK DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4157
Practice Address - Country:US
Practice Address - Phone:979-297-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist