Provider Demographics
NPI:1346741477
Name:BRAIMAH, AYEMOBA OMO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AYEMOBA
Middle Name:OMO
Last Name:BRAIMAH
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 1:10900 S PENNSYLVANIA AVE APT 1136
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4250
Mailing Address - Country:US
Mailing Address - Phone:404-704-4284
Mailing Address - Fax:
Practice Address - Street 1:8245 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-4722
Practice Address - Country:US
Practice Address - Phone:623-849-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist