Provider Demographics
NPI:1669054755
Name:OLANIPEKUN, OLUWAPAMILERIN ADEOLA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:OLUWAPAMILERIN
Middle Name:ADEOLA
Last Name:OLANIPEKUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 HOCKLEY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2032
Mailing Address - Country:US
Mailing Address - Phone:904-402-7347
Mailing Address - Fax:
Practice Address - Street 1:825 S CROWLEY RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3663
Practice Address - Country:US
Practice Address - Phone:817-297-2281
Practice Address - Fax:817-297-3153
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1964074OtherCVS PHARMACY EIN