Provider Demographics
NPI:1508137951
Name:ODUFUYE, COMFORT YETUNDE
Entity Type:Individual
Prefix:MRS
First Name:COMFORT
Middle Name:YETUNDE
Last Name:ODUFUYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2937
Mailing Address - Country:US
Mailing Address - Phone:512-323-6098
Mailing Address - Fax:
Practice Address - Street 1:4501 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2937
Practice Address - Country:US
Practice Address - Phone:512-323-6098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist