Provider Demographics
NPI:1134624554
Name:OGUNDIYA, OLA BIDEX (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:OLA
Middle Name:BIDEX
Last Name:OGUNDIYA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 S REUNION DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2250
Mailing Address - Country:US
Mailing Address - Phone:773-708-2305
Mailing Address - Fax:
Practice Address - Street 1:3555 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109
Practice Address - Country:US
Practice Address - Phone:318-525-0144
Practice Address - Fax:318-525-0222
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64472OtherPHAMD, RPH
LAPST.022417OtherPHARMACIST