Modupe Mary Famodimu, PHARM.D

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

53736 Issued in TX

Practice address

5501 Independence Pkwy Ste 311
Plano, TX 75023-5468

Phone

(832) 755-3078

NPI assigned

Sep 9, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reussi Healthcare PLLC

  • Clinic Pharmacy
  • Plano, TX
  • NPI 1306587621

  Pharmacist Clinician (PHC)/ Clinical Pharmacy Specialist

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1801221817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8055 WINDROSE AVE APT 3121",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750240268",
            "telephone_number": "832-755-3078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 INDEPENDENCE PKWY STE 311",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750235468",
            "telephone_number": "832-755-3078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAMODIMU",
        "first_name": "MODUPE",
        "middle_name": "MARY",
        "credential": "PHARM.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-09",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TX",
            "license": "53736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cdrive",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5501 Independence Pkwy Ste 311",
            "city": "Plano",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750235468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Family Practice Specialists & WHC
• Family Practice Specialists,PA
• Family Tree Community Care
• Family Tree Counseling, PLLC
• Family Tree Counseling, PLLC
• Benjamin Fan, DDS
• Christopher Fan
• Ellen Fan, M.D.
• Jenny Fan, O.D.
• William Fan, O.D.

• All providers in Plano, TX
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.