Provider Demographics
NPI:1780318857
Name:OSA-EDOH, NOSAKHARE EMMANUEL (RPH)
Entity type:Individual
Prefix:DR
First Name:NOSAKHARE
Middle Name:EMMANUEL
Last Name:OSA-EDOH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 OAKMONT DR UNIT 1307
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2553
Mailing Address - Country:US
Mailing Address - Phone:314-604-2419
Mailing Address - Fax:
Practice Address - Street 1:101 NACO HWY
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603
Practice Address - Country:US
Practice Address - Phone:520-432-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist