Provider Demographics
NPI:1205473279
Name:OLABODE, OLAKUNLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:OLAKUNLE
Middle Name:
Last Name:OLABODE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 MOUNTAIN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-2028
Mailing Address - Country:US
Mailing Address - Phone:214-708-1564
Mailing Address - Fax:
Practice Address - Street 1:5675 MOUNTAIN HOLLOW DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-2028
Practice Address - Country:US
Practice Address - Phone:214-708-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist