Provider Demographics
NPI:1053624676
Name:OMORUYI, FLORENCE
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:OMORUYI
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 1:2168B TEXAS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3122
Mailing Address - Country:US
Mailing Address - Phone:281-969-8161
Mailing Address - Fax:
Practice Address - Street 1:2168B TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3122
Practice Address - Country:US
Practice Address - Phone:281-969-8161
Practice Address - Fax:281-969-8178
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist