Healthcare Provider Details

I. General information

NPI: 1386465748
Provider Name (Legal Business Name): OYINDAMOLA AYOMIDE OLORUNFEMI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 S LOOP 256 C/O PHARMACY DEPARTMENT
PALESTINE TX
75801-6958
US

IV. Provider business mailing address

2900 S LOOP 256 C/O PHARMACY DEPARTMENT
PALESTINE TX
75801-6958
US

V. Phone/Fax

Practice location:
  • Phone: 803-447-9219
  • Fax:
Mailing address:
  • Phone: 803-447-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: