Provider Demographics
NPI:1871804674
Name:ODUSOLA, AKINWUNMI
Entity type:Individual
Prefix:
First Name:AKINWUNMI
Middle Name:
Last Name:ODUSOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13032 WANDERING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-1502
Mailing Address - Country:US
Mailing Address - Phone:908-930-1387
Mailing Address - Fax:
Practice Address - Street 1:3901 E DAVIS ST STE 1
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-7236
Practice Address - Country:US
Practice Address - Phone:936-760-6600
Practice Address - Fax:936-760-6606
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist