Provider Demographics
NPI:1922727379
Name:OGUNDAYOMI, OLORUNTOBA ADE
Entity Type:Individual
Prefix:DR
First Name:OLORUNTOBA
Middle Name:ADE
Last Name:OGUNDAYOMI
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 1:2840 SHADOWBRIAR DR APT 1413
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3292
Mailing Address - Country:US
Mailing Address - Phone:281-250-8815
Mailing Address - Fax:
Practice Address - Street 1:2840 SHADOWBRIAR DR APT 1413
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3292
Practice Address - Country:US
Practice Address - Phone:281-250-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist