Healthcare Provider Details

I. General information

NPI: 1861267528
Provider Name (Legal Business Name): ADWOA ODURO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 SPRINGSIDE ST
PLAINFIELD IL
60586-1064
US

IV. Provider business mailing address

25825 SPRINGSIDE ST
PLAINFIELD IL
60586-1064
US

V. Phone/Fax

Practice location:
  • Phone: 815-302-3924
  • Fax:
Mailing address:
  • Phone: 815-302-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.305985
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: