Healthcare Provider Details

I. General information

NPI: 1700233210
Provider Name (Legal Business Name): CHARLES LWANGA OLALY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 SW COURT PL
PENDLETON OR
97801-1896
US

IV. Provider business mailing address

2203 SW COURT PL
PENDLETON OR
97801-1896
US

V. Phone/Fax

Practice location:
  • Phone: 832-920-9421
  • Fax:
Mailing address:
  • Phone: 832-920-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0015235
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: