Healthcare Provider Details

I. General information

NPI: 1700162906
Provider Name (Legal Business Name): TITILOLA O OGUNDIYA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 DICKERSON ROAD WALGREEN
NASHVILLE TN
37207-1321
US

IV. Provider business mailing address

3500 GALLATIN PIKE WALGREENS PHARMACY
NASHVILLE TN
37216
US

V. Phone/Fax

Practice location:
  • Phone: 615-228-2982
  • Fax: 615-228-4019
Mailing address:
  • Phone: 615-228-2982
  • Fax: 615-228-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1147130
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: