Provider Demographics
NPI:1093491755
Name:PETERS, OLUWOLE OLUGBENGA (PHARMD)
Entity Type:Individual
Prefix:
First Name:OLUWOLE
Middle Name:OLUGBENGA
Last Name:PETERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 ROARING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1244
Mailing Address - Country:US
Mailing Address - Phone:682-718-0506
Mailing Address - Fax:
Practice Address - Street 1:3710 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5204
Practice Address - Country:US
Practice Address - Phone:903-785-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist