Provider Demographics
NPI:1265619738
Name:ODUNAJYA, PERPETUA O
Entity type:Individual
Prefix:
First Name:PERPETUA
Middle Name:O
Last Name:ODUNAJYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 BEACH 69TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1321
Mailing Address - Country:US
Mailing Address - Phone:347-926-4753
Mailing Address - Fax:
Practice Address - Street 1:538 BEACH 69TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1321
Practice Address - Country:US
Practice Address - Phone:347-926-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY442651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist