MEDICARE: OREOLUWA OLUWATUNMISE ABIMBOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	75429	TX

General Provider Information

NPI Number	:	1043018005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OREOLUWA OLUWATUNMISE ABIMBOLA

Provider Business Mailing Address
First Line	:	6205 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4313
Country	:	US
Telephone Number	:	817-263-0962
Fax Number	:

Provider Business Practice Location Address
First Line	:	6205 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4313
Country	:	US
Telephone Number	:	817-263-0962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	09/08/2025

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