Provider Demographics
NPI:1700168846
Name:OKUNADE, OLATOUN
Entity Type:Individual
Prefix:MRS
First Name:OLATOUN
Middle Name:
Last Name:OKUNADE
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 1:6672 E SHELBY DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8439
Mailing Address - Country:US
Mailing Address - Phone:901-368-6675
Mailing Address - Fax:901-368-4812
Practice Address - Street 1:6672 E SHELBY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8439
Practice Address - Country:US
Practice Address - Phone:901-368-6675
Practice Address - Fax:901-368-4812
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist