MEDICARE: OLUWASEGUN OYENPEMI PHARMD

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	68525	TX

General Provider Information

NPI Number	:	1780359802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWASEGUN OYENPEMI PHARMD

Provider Business Mailing Address
First Line	:	1311 S JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-3050
Country	:	US
Telephone Number	:	903-589-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 S JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-3050
Country	:	US
Telephone Number	:	903-589-3434
Fax Number	:

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

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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