Provider Demographics
NPI:1568671451
Name:ODUYALE, OLUGBENGA SOLOMON (RPH)
Entity type:Individual
Prefix:MR
First Name:OLUGBENGA
Middle Name:SOLOMON
Last Name:ODUYALE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3274
Mailing Address - Country:US
Mailing Address - Phone:928-210-0659
Mailing Address - Fax:928-726-5855
Practice Address - Street 1:2209 E 27TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3274
Practice Address - Country:US
Practice Address - Phone:928-210-0659
Practice Address - Fax:928-726-5855
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist