Provider Demographics
NPI:1831706134
Name:WIMBERLY, OLAYIDE SHODUNKE
Entity type:Individual
Prefix:
First Name:OLAYIDE
Middle Name:SHODUNKE
Last Name:WIMBERLY
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 1:8111 QUIVIRA RD APT 12309
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2777
Mailing Address - Country:US
Mailing Address - Phone:312-720-9083
Mailing Address - Fax:
Practice Address - Street 1:8300 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1143
Practice Address - Country:US
Practice Address - Phone:913-403-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist