Active NPI
Collins O Odukogbe, PHARMD
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Shaw AFB, SC
National Provider Identifier
1295015584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 12442
- Practice address
- 431 Meadowlark St
Shaw a F B, SC 29152-5019 - Phone
- (803) 895-2273
- NPI assigned
- Aug 18, 2011
- Last updated
- Aug 18, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 12442 | SC | Primary |
Addresses
Primary practice location
431 Meadowlark St
Shaw a F B, SC 29152-5019
Mailing address
164 Seaton Ridge Dr
Blythewood, SC 29016-9246
Phone (803) 467-9172
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12442 | Other | SC | STATE |
| 20070 | Other | NC | STATE LICENSE |
| RP443290 | Other | PA | STATE |
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12442 | SC | MD | Social Worker |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Qsrex Pharmacy
- Community/Retail Pharmacy
- Columbia, SC
- NPI 1003241258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1295015584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 SEATON RIDGE DR",
"city": "BLYTHEWOOD",
"state": "SC",
"postal_code": "290169246",
"telephone_number": "803-467-9172",
"fax_number": "803-807-9111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "431 MEADOWLARK ST",
"city": "SHAW A F B",
"state": "SC",
"postal_code": "291525019",
"telephone_number": "803-895-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODUKOGBE",
"first_name": "COLLINS",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-18",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "SC",
"license": "12442",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "12442",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "20070",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "RP443290",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shaw AFB, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.