Provider Demographics
NPI:1043699325
Name:OMOYOSI, ADEKUNLE C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADEKUNLE
Middle Name:C
Last Name:OMOYOSI
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 1:8515 FONDREN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-7070
Mailing Address - Country:US
Mailing Address - Phone:713-487-7466
Mailing Address - Fax:
Practice Address - Street 1:8515 FONDREN RD STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7070
Practice Address - Country:US
Practice Address - Phone:713-487-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 174H00000X, 246ZB0500X
TX55105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist