Individual
BO SIJUWADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8113 RIDGEPOINT DR, SUITE 200, IRVING, TX 75063-3197
(972) 556-1623
Mailing address
PO BOX 381172, DUNCANVILLE, TX 75138-1172
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
49259
TX
Other
Enumeration date
09/21/2011
Last updated
03/07/2012
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