DIEUDONNE F FOMBOH (NPI# 1568896702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568896702 |
| Entity Type | Individual |
| Full Name | DIEUDONNE F FOMBOH |
| Practice Address |
5415 S Broadway Ave Tyler TX 75703-1397 |
| Mailing Address |
2051 W Cumberland Rd Apt 1034 Tyler TX 75703-5343 |
| Practice Telephone | 9039399298 |
| Mailing Telephone | 7574394136 |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2013-08-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 53837 | TX | Pharmacy Service Providers |
| Street Address |
5415 S BROADWAY AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75703-1397 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679588669 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2006-07-29 |
| 1154873941 | Nkechi Alexandra Anako | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2016-10-27 |
| 1437515400 | Augustine Owusu | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2016-01-06 |
| 1427423326 | Daniel Chi Loc Mai | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2015-12-03 |
| 1013380781 | Sarah Kang | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2015-11-03 |
| 1205236981 | Evans Ofosu | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2014-08-29 |
| 1891195152 | Camille Hightower | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2014-08-23 |
| 1770917999 | Brenda Tsehainzu Mbipeh | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2013-08-23 |
| 1194072116 | Kendall Robert Lemke | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2012-08-08 |
| 1851674592 | Kenneth Ward | Pharmacist | 5415 S Broadway Ave, Tyler, TX 75703-1397 | 2011-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669073433 | Josephine S Asamoah | Pharmacist | 3820 Tx-64, Tyler, TX 75704-5582 | 2020-11-06 |
| 1790386738 | Jennifer O Jackson | Pharmacist | 1900 Ese Loop323, Tyler, TX 75701-8337 | 2020-11-05 |
| 1528669132 | Youness Ennouri | Pharmacist | 2025 Ssw Loop 323, Tyler, TX 75701-0763 | 2020-11-02 |
| 1194325415 | Rupal R Patel | Pharmacist | 3820 Tx 64, Tyler, TX 75704 | 2020-10-27 |
| 1528673597 | Holly Beth Lutmer | Pharmacist | 4901 Kinsey Dr Apt 1723, Tyler, TX 75703-3033 | 2020-09-15 |
| 1558976498 | Traci Carroll George | Pharmacist | 1600 W Sw Loop 323, Tyler, TX 75701-8532 | 2020-09-08 |
| 1538773213 | Zachary Thompson | Pharmacist | 19201 Oakbrook Rd, Tyler, TX 75703-8233 | 2020-09-01 |
| 1699392407 | Cathlyn Yu | Pharmacist | 13157 Hwy 271, Tyler, TX 75708-2453 | 2020-06-26 |
| 1245878826 | Kim Annette Parks | Pharmacist | 113 Nnw Loop 323, Tyler, TX 75702-8725 | 2019-12-14 |
| 1366003063 | Austin J Dowell | Pharmacist | 4290 Kinsey Dr Ste 100, Tyler, TX 75703-1022 | 2019-06-24 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.