Healthcare Provider Details

I. General information

NPI: 1972886166
Provider Name (Legal Business Name): ADEDOYIN OKUNOREN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LAKELAND DR
DALLAS TX
75228-5353
US

IV. Provider business mailing address

1800 E SPRING CREEK PKWY APT 1125
PLANO TX
75074-3200
US

V. Phone/Fax

Practice location:
  • Phone: 214-321-0197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: