Provider Demographics
NPI:1598365769
Name:ODOWA, NUR I
Entity Type:Individual
Prefix:
First Name:NUR
Middle Name:I
Last Name:ODOWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RED ROCK RD APT 107
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1831
Mailing Address - Country:US
Mailing Address - Phone:612-877-1012
Mailing Address - Fax:
Practice Address - Street 1:1133 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-2304
Practice Address - Country:US
Practice Address - Phone:651-455-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist