Provider Demographics
NPI:1720589062
Name:OLAWOYIN, OLATUNDUN ANIKE
Entity Type:Individual
Prefix:
First Name:OLATUNDUN
Middle Name:ANIKE
Last Name:OLAWOYIN
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 1:4245 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3888
Mailing Address - Country:US
Mailing Address - Phone:202-701-6221
Mailing Address - Fax:
Practice Address - Street 1:4460 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4312
Practice Address - Country:US
Practice Address - Phone:337-478-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0222369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist