Provider Demographics
NPI:1720506983
Name:ODEYEMI, LATEEF (PHARMD)
Entity Type:Individual
Prefix:
First Name:LATEEF
Middle Name:
Last Name:ODEYEMI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MCKEEN PL APT 68
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4475
Mailing Address - Country:US
Mailing Address - Phone:318-243-4748
Mailing Address - Fax:
Practice Address - Street 1:10374 HIGHWAY 165 N STE C
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3369
Practice Address - Country:US
Practice Address - Phone:318-812-2305
Practice Address - Fax:318-665-0092
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist