Healthcare Provider Details

I. General information

NPI: 1073109310
Provider Name (Legal Business Name): ADENIKE OKODUWA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 SILVER CREEK RD
BULLHEAD CITY AZ
86442-7924
US

IV. Provider business mailing address

1570 PASEO GRANDE APT 2036
BULLHEAD CITY AZ
86442-8529
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-0258
  • Fax:
Mailing address:
  • Phone: 410-212-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025048
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: