Provider Demographics
NPI:1730462508
Name:ONOSODE, NNENNA QUEENDERLIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NNENNA
Middle Name:QUEENDERLIN
Last Name:ONOSODE
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 1:4800 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1707
Mailing Address - Country:US
Mailing Address - Phone:502-491-8774
Mailing Address - Fax:
Practice Address - Street 1:4800 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1707
Practice Address - Country:US
Practice Address - Phone:502-491-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist