Provider Demographics
NPI:1568657377
Name:ODUNSI, AYO O (PHARMACIST)
Entity type:Individual
Prefix:
First Name:AYO
Middle Name:O
Last Name:ODUNSI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MEADOWS PKWY APT 513
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3977
Mailing Address - Country:US
Mailing Address - Phone:702-439-9930
Mailing Address - Fax:775-852-1609
Practice Address - Street 1:6450 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1103
Practice Address - Country:US
Practice Address - Phone:775-852-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist