Kehinde Olawale Bashua
Individual provider Active NPI Pharmacist · Palestine, TX
NPI 1154787000 · NPPES record last updated Jan 7, 2016
Key facts
- NPI
- 1154787000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 57602 (TX)
- Practice address
- 2201 S Loop 256
Palestine, TX 75801-4701 - Phone
- (903) 723-4705
- NPI assigned
- Jan 7, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 57602 | TX | Yes |
Addresses
Primary practice location
2201 S Loop 256
Palestine, TX 75801-4701
Mailing address
2201 S Loop 256
Palestine, TX 75801-4701
Phone (903) 723-4705
Other providers in Palestine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.