Provider Demographics
NPI:1366512386
Name:ODUBELE, ANTHONY E
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:ODUBELE
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:PO BOX 771803
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77215-1803
Mailing Address - Country:US
Mailing Address - Phone:713-774-7200
Mailing Address - Fax:713-774-7294
Practice Address - Street 1:10039 BISSONNET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7854
Practice Address - Country:US
Practice Address - Phone:713-774-7200
Practice Address - Fax:713-774-7294
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist