Individual
EBOT NDEMAZE TAKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
4415 N STATELINE AVE, TEXARKANA, TX 75503-3138
(240) 704-4117
Mailing address
3506 SKYLINE BLVD APT 22, TEXARKANA, TX 75503-1433
(240) 704-4117
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
66729
TX
374U00000X
Home Health Aide
—
—
Other
Enumeration date
05/24/2012
Last updated
06/07/2022
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