Provider Demographics
NPI:1467821454
Name:ODENIGBO, CASEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:ODENIGBO
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 1:690 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7692
Mailing Address - Country:US
Mailing Address - Phone:989-793-5701
Mailing Address - Fax:989-771-7051
Practice Address - Street 1:690 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7692
Practice Address - Country:US
Practice Address - Phone:989-992-5710
Practice Address - Fax:989-771-7051
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2021-08-23
Deactivation Date:2018-04-05
Deactivation Code:
Reactivation Date:2021-08-11
Provider Licenses
StateLicense IDTaxonomies
MI5302042398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist