Provider Demographics
NPI:1225755861
Name:ODHIAMBO, ROSELYNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROSELYNE
Middle Name:
Last Name:ODHIAMBO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:CLAIRE
Other - Last Name:ODHIAMBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4750 HAVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4229
Mailing Address - Country:US
Mailing Address - Phone:469-988-9848
Mailing Address - Fax:
Practice Address - Street 1:4750 HAVERWOOD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4229
Practice Address - Country:US
Practice Address - Phone:469-988-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist