Healthcare Provider Details

I. General information

NPI: 1114546405
Provider Name (Legal Business Name): JENNIE J OLOPAADE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 FRANCISCAN DR APT 625
ARLINGTON TX
76015-2543
US

IV. Provider business mailing address

3012 FRANCISCAN DR APT 625
ARLINGTON TX
76015-2543
US

V. Phone/Fax

Practice location:
  • Phone: 251-599-9800
  • Fax:
Mailing address:
  • Phone: 251-599-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64652
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15474
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: