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General NPI Number Information
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NPI Number | 1093491755
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Entity Type | Individual
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Provider Name | OLUWOLE OLUGBENGA PETERS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 3710 LAMAR AVE
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City | PARIS
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State | TX
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Zip | 75462-5204
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Country | US
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Telephone | 903-785-0736
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Fax |
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Provider Business Mailing Address
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Address Line | 859 ROARING SPRINGS RD
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-1244
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Country | US
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Telephone | 682-718-0506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 41848
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License Number State | TX
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