Provider Demographics
NPI:1568874980
Name:ODUTOLA, KEHINDE ADEDAPO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEHINDE
Middle Name:ADEDAPO
Last Name:ODUTOLA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 BUSINESS CENTER DR
Mailing Address - Street 2:APT 123
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2295
Mailing Address - Country:US
Mailing Address - Phone:832-623-2770
Mailing Address - Fax:
Practice Address - Street 1:2526 BUSINESS CENTER DR
Practice Address - Street 2:APT 123
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2295
Practice Address - Country:US
Practice Address - Phone:832-623-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50042OtherTEXAS STATE BOARD OF PHARMACY