Provider Demographics
NPI:1891397873
Name:USORO, OWOEDIMO BENEDICT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OWOEDIMO
Middle Name:BENEDICT
Last Name:USORO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TURNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2066
Mailing Address - Country:US
Mailing Address - Phone:201-707-0946
Mailing Address - Fax:
Practice Address - Street 1:1635 MARKET PL
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7239
Practice Address - Country:US
Practice Address - Phone:214-574-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054413183500000X
NJ28RI03241200183500000X
TX46880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist