Provider Demographics
NPI:1992033286
Name:FASONU, OLAMIDE T (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:OLAMIDE
Middle Name:T
Last Name:FASONU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 W WHEATLAND RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4063
Mailing Address - Country:US
Mailing Address - Phone:972-709-2190
Mailing Address - Fax:
Practice Address - Street 1:4041 W WHEATLAND RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4063
Practice Address - Country:US
Practice Address - Phone:972-709-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist