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General NPI Number Information
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NPI Number | 1295015584
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Entity Type | Individual
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Provider Name | COLLINS O ODUKOGBE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 431 MEADOWLARK ST
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City | SHAW A F B
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State | SC
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Zip | 29152-5019
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Country | US
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Telephone | 803-895-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 164 SEATON RIDGE DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-9246
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Country | US
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Telephone | 803-467-9172
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Fax | 803-807-9111
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 12442
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License Number State | SC
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