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General NPI Number Information
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NPI Number | 1881176899
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Entity Type | Individual
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Provider Name | AZEEZ OLABODE
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Gender | Male
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 681 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97301-4733
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Country | US
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Telephone | 503-585-7616
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Fax |
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Provider Business Mailing Address
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Address Line | 4014 ADEN PL NE
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City | SALEM
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State | OR
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Zip | 97305-1790
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Country | US
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Telephone | 817-983-8122
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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 | 0016823
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License Number State | OR
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