Healthcare Provider Details

I. General information

NPI: 1700168846
Provider Name (Legal Business Name): MRS. OLATOUN OKUNADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6672 E SHELBY DR
MEMPHIS TN
38141-8439
US

IV. Provider business mailing address

6672 E SHELBY DR
MEMPHIS TN
38141-8439
US

V. Phone/Fax

Practice location:
  • Phone: 901-368-6675
  • Fax: 901-368-4812
Mailing address:
  • Phone: 901-368-6675
  • Fax: 901-368-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7194
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: