Active NPI
Samuel O Odunlami, RPH
- Pharmacist
- West Bloomfield, MI
National Provider Identifier
1104084946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302027019
- Practice address
- 5970 Crestwood Dr
West Bloomfield, MI 48322-2001 - Phone
- (248) 661-1092
- NPI assigned
- May 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302027019 | MI | Primary |
| Pharmacotherapy Pharmacist | 1835P1200X | 5302027019 | MI |
Addresses
Primary practice location
5970 Crestwood Dr
West Bloomfield, MI 48322-2001
Mailing address
5970 Crestwood Dr
Westbloomfield, MI 48322
Phone (248) 661-1092
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302027019 | MI | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212019200000",
"number": "1104084946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5970 CRESTWOOD DR",
"city": "WESTBLOOMFIELD",
"state": "MI",
"postal_code": "48322",
"telephone_number": "248-661-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5970 CRESTWOOD DR",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483222001",
"telephone_number": "248-661-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODUNLAMI",
"first_name": "SAMUEL",
"middle_name": "O",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-29",
"last_updated": "2008-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302027019",
"primary": true
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "MI",
"license": "5302027019",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.