Provider Demographics
NPI:1700162906
Name:OGUNDIYA, TITILOLA O (RPH)
Entity Type:Individual
Prefix:
First Name:TITILOLA
Middle Name:O
Last Name:OGUNDIYA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GALLATIN PIKE
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216
Mailing Address - Country:US
Mailing Address - Phone:615-228-2982
Mailing Address - Fax:615-228-4019
Practice Address - Street 1:3880 DICKERSON ROAD
Practice Address - Street 2:WALGREEN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-1321
Practice Address - Country:US
Practice Address - Phone:615-228-2982
Practice Address - Fax:615-228-4019
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1147130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1147130OtherTN PHARMACIST LICENSE NO