John Etakibuebu, PHARMD
Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Henderson, TX
NPI 1184264384 · NPPES record last updated Jan 15, 2020
Key facts
- NPI
- 1184264384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- License
- 54248 (TX)
- Practice address
- 2415 Hwy 79 S
Henderson, TX 75652 - Phone
- (903) 657-8596
- NPI assigned
- Jan 15, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54248 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Texas L P | Past |
Accepting new patients | |
| Kroger Texas LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 54248 | TX | Yes |
Addresses
Primary practice location
2415 Hwy 79 S
Henderson, TX 75652
Mailing address
2415 Hwy 79 S
Henderson, TX 75652
Phone (903) 657-8596
Other providers in Henderson, TX
- Tarek Elmajie
- Jacqueline Ervin
- Esc IV, L.P.
- Sandra Lylia Escamilla
- Bonnie L Estes
- Etmc Physician Group Inc.
- Family Care of Henderson, PLLC
- Charles Michael Flint
- Anabel Flores
- Peggie Foreman
All providers in Henderson, TX · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2020. 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.