Provider Demographics
NPI:1477211647
Name:ODUOGU, COLLINS (PHARMD)
Entity type:Individual
Prefix:
First Name:COLLINS
Middle Name:
Last Name:ODUOGU
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:PO BOX 925903
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-5903
Mailing Address - Country:US
Mailing Address - Phone:713-884-9259
Mailing Address - Fax:
Practice Address - Street 1:5003 ANTOINE DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-3348
Practice Address - Country:US
Practice Address - Phone:713-290-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist