Provider Demographics
NPI:1245826767
Name:OKESANYA, AKINGBADE OLUSEGUN
Entity type:Individual
Prefix:
First Name:AKINGBADE
Middle Name:OLUSEGUN
Last Name:OKESANYA
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 1:832 S CARRIER PKWY # 130
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-0942
Mailing Address - Country:US
Mailing Address - Phone:214-330-2424
Mailing Address - Fax:214-330-2942
Practice Address - Street 1:832 S CARRIER PKWY # 130
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-0942
Practice Address - Country:US
Practice Address - Phone:214-330-2424
Practice Address - Fax:214-330-2492
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist