Provider Demographics
NPI:1033710678
Name:OLAYIWOLA, ZAINAB TAIWO
Entity Type:Individual
Prefix:
First Name:ZAINAB
Middle Name:TAIWO
Last Name:OLAYIWOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-9738
Mailing Address - Country:US
Mailing Address - Phone:325-942-7682
Mailing Address - Fax:325-942-7684
Practice Address - Street 1:5501 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-9738
Practice Address - Country:US
Practice Address - Phone:325-942-7682
Practice Address - Fax:325-942-7684
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist