Provider Demographics
NPI:1982932174
Name:ODUMOSU, AIMALOHI OMIORORO (RPH)
Entity type:Individual
Prefix:MRS
First Name:AIMALOHI
Middle Name:OMIORORO
Last Name:ODUMOSU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 RIVER TRCE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9549
Mailing Address - Country:US
Mailing Address - Phone:210-290-9525
Mailing Address - Fax:
Practice Address - Street 1:9080 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1810
Practice Address - Country:US
Practice Address - Phone:210-673-3082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-26
Last Update Date:2009-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist