Provider Demographics
NPI:1205567278
Name:IDODO, USMAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:USMAN
Middle Name:
Last Name:IDODO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALLOWAY CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3466
Mailing Address - Country:US
Mailing Address - Phone:469-504-3916
Mailing Address - Fax:
Practice Address - Street 1:901 S CROWLEY RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3639
Practice Address - Country:US
Practice Address - Phone:817-297-1734
Practice Address - Fax:817-297-1869
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist