Provider Demographics
NPI:1700489895
Name:EBHOHON, WILSON IRABOR
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:IRABOR
Last Name:EBHOHON
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 1:4100 DE ZAVALA RD
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2074
Mailing Address - Country:US
Mailing Address - Phone:210-492-9741
Mailing Address - Fax:
Practice Address - Street 1:4100 DE ZAVALA RD
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-2074
Practice Address - Country:US
Practice Address - Phone:210-492-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist