Provider Demographics
NPI:1316215874
Name:ODURO, SAMUEL ANNOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANNOR
Last Name:ODURO
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 1:3240 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4512
Mailing Address - Country:US
Mailing Address - Phone:651-329-3132
Mailing Address - Fax:
Practice Address - Street 1:3240 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4512
Practice Address - Country:US
Practice Address - Phone:651-329-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1201431835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy