Provider Demographics
NPI:1336801059
Name:MAKINDE, OLUTOYIN EZEKIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:OLUTOYIN
Middle Name:EZEKIEL
Last Name:MAKINDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 TERESA LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2816
Mailing Address - Country:US
Mailing Address - Phone:682-251-5689
Mailing Address - Fax:
Practice Address - Street 1:3145 MANSFIELD HWY
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-5938
Practice Address - Country:US
Practice Address - Phone:817-535-1182
Practice Address - Fax:817-534-4089
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist