Healthcare Provider Details

I. General information

NPI: 1134624554
Provider Name (Legal Business Name): OLA BIDEX OGUNDIYA PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 GREENWOOD RD
SHREVEPORT LA
71109
US

IV. Provider business mailing address

1733 S REUNION DR
SHREVEPORT LA
71118-2250
US

V. Phone/Fax

Practice location:
  • Phone: 318-525-0144
  • Fax: 318-525-0222
Mailing address:
  • Phone: 773-708-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.022417
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: