Provider Demographics
NPI:1861900425
Name:OLUBELA, OLUKOREDE R (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:OLUKOREDE
Middle Name:R
Last Name:OLUBELA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:OLUKOREDE
Other - Middle Name:R
Other - Last Name:OLUBELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:944 BICHARA BLVD
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-7714
Mailing Address - Country:US
Mailing Address - Phone:352-753-6115
Mailing Address - Fax:
Practice Address - Street 1:944 BICHARA BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-7714
Practice Address - Country:US
Practice Address - Phone:352-753-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist