Provider Demographics
NPI:1669824215
Name:OLADIRAN, OLADELE
Entity Type:Individual
Prefix:
First Name:OLADELE
Middle Name:
Last Name:OLADIRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6020
Mailing Address - Country:US
Mailing Address - Phone:318-352-2546
Mailing Address - Fax:
Practice Address - Street 1:601 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6020
Practice Address - Country:US
Practice Address - Phone:318-352-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021574183500000X
MS14282183500000X
TX45985183500000X
MD17309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist