Provider Demographics
NPI:1346019452
Name:AYANDA, OLUWADAMILOLA
Entity Type:Individual
Prefix:
First Name:OLUWADAMILOLA
Middle Name:
Last Name:AYANDA
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 1:3507 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5378
Mailing Address - Country:US
Mailing Address - Phone:682-718-5848
Mailing Address - Fax:
Practice Address - Street 1:105 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4216
Practice Address - Country:US
Practice Address - Phone:972-617-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist