Provider Demographics
NPI:1689279291
Name:ODOEMENA, NNEOMA SANDRA (RPH)
Entity Type:Individual
Prefix:DR
First Name:NNEOMA
Middle Name:SANDRA
Last Name:ODOEMENA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3702
Mailing Address - Country:US
Mailing Address - Phone:973-931-0328
Mailing Address - Fax:
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5645
Practice Address - Country:US
Practice Address - Phone:973-325-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04133400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist