Provider Demographics
NPI:1164119251
Name:ODUH, PHILIP OSONDU
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:OSONDU
Last Name:ODUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9944 GRANDE LAKES BLVD APT 3125
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4060
Mailing Address - Country:US
Mailing Address - Phone:561-207-1466
Mailing Address - Fax:
Practice Address - Street 1:395 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3326
Practice Address - Country:US
Practice Address - Phone:407-343-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist