Provider Demographics
NPI:1336707652
Name:OLAIYA, FOALSHADE OLABISI
Entity Type:Individual
Prefix:
First Name:FOALSHADE
Middle Name:OLABISI
Last Name:OLAIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0033
Mailing Address - Country:US
Mailing Address - Phone:678-267-6869
Mailing Address - Fax:
Practice Address - Street 1:3201 TUCKER NORCROSS RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2150
Practice Address - Country:US
Practice Address - Phone:770-225-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist