Individual
DR. COLLINS O ODUKOGBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
431 MEADOWLARK ST, SHAW A F B, SC 29152-5019
(803) 895-2273
Mailing address
164 SEATON RIDGE DR, BLYTHEWOOD, SC 29016-9246
(803) 467-9172
(803) 807-9111
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
12442
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12442
STATE
SC
01
—
20070
STATE LICENSE
NC
01
—
RP443290
STATE
PA
Enumeration date
08/18/2011
Last updated
08/18/2011
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