Organization
MONA ODUSOLA
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
12121 RICHMOND AVE, SUITE 126, HOUSTON, TX 77082-2432
(281) 558-9433
(281) 558-9017
Mailing address
12121 RICHMOND AVE, SUITE 126, HOUSTON, TX 77082-2432
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
19895
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144930
—
TX
01
—
4572194
OTHER ID NUMBER
—
Enumeration date
11/15/2006
Last updated
06/27/2008
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