=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285461723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. OMOSHOLA BENARDINAH KEHINDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2024
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 E 4TH ST
-----------------------------------------------------
City | MONAHANS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79756-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-943-4212
-----------------------------------------------------
Fax | 432-943-7503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 829 COEN
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79766-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 70272
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------