Provider Demographics
NPI:1609170026
Name:SODIYA, ENITAN O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ENITAN
Middle Name:O
Last Name:SODIYA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 MERRIMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-5212
Mailing Address - Country:US
Mailing Address - Phone:248-935-1241
Mailing Address - Fax:
Practice Address - Street 1:10652 GRATIOT AVE
Practice Address - Street 2:CVS #8283
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1200
Practice Address - Country:US
Practice Address - Phone:313-571-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist