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General NPI Number Information
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NPI Number | 1952473753
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Entity Type | Organization
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Legal Business Name | MONA ODUSOLA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 12121 RICHMOND AVE SUITE 126
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City | HOUSTON
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State | TX
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Zip | 77082-2432
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Country | US
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Telephone | 281-558-9433
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Fax | 281-558-9017
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Provider Business Mailing Address
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Address Line | 12121 RICHMOND AVE SUITE 126
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City | HOUSTON
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State | TX
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Zip | 77082-2432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THIRD PARTY PLAN COORDINATOR
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Name | DENA FERMAN
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Credential |
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Telephone | 314-993-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 19895
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License Number State | TX
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