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General NPI Number Information
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NPI Number | 1558084046
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Entity Type | Individual
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Provider Name | OLALEKAN OLATUNDE SHODIPO PHARM D
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Gender | Male
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 9663 FM 1097 RD W
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City | WILLIS
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State | TX
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Zip | 77318-5299
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Country | US
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Telephone | 936-228-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 32702 TURNING SPRINGS DR
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City | BROOKSHIRE
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State | TX
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Zip | 77423-2797
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Country | US
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Telephone | 936-676-5735
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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 | 52566
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License Number State | TX
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