Provider Demographics
NPI:1144572918
Name:ONOSODE, OTIBHOR A (RPH, PHARMD, MSC,)
Entity Type:Individual
Prefix:DR
First Name:OTIBHOR
Middle Name:A
Last Name:ONOSODE
Suffix:
Gender:F
Credentials:RPH, PHARMD, MSC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 PEBBLE HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3585
Mailing Address - Country:US
Mailing Address - Phone:248-346-1179
Mailing Address - Fax:
Practice Address - Street 1:3129 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4367
Practice Address - Country:US
Practice Address - Phone:281-980-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52923183500000X
MI5302037664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist