Provider Demographics
NPI:1700191087
Name:APENA, OLUSOLA OLAWALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLUSOLA
Middle Name:OLAWALE
Last Name:APENA
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 1:3239 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1066
Mailing Address - Country:US
Mailing Address - Phone:352-213-4714
Mailing Address - Fax:
Practice Address - Street 1:3239 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1066
Practice Address - Country:US
Practice Address - Phone:352-213-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist