Provider Demographics
NPI:1558084046
Name:SHODIPO, OLALEKAN OLATUNDE (PHARM D)
Entity Type:Individual
Prefix:
First Name:OLALEKAN
Middle Name:OLATUNDE
Last Name:SHODIPO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32702 TURNING SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-2797
Mailing Address - Country:US
Mailing Address - Phone:936-676-5735
Mailing Address - Fax:
Practice Address - Street 1:9663 FM 1097 RD W
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-5299
Practice Address - Country:US
Practice Address - Phone:936-228-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist