Provider Demographics
NPI:1932065620
Name:OWODUNNI, OLA
Entity type:Individual
Prefix:
First Name:OLA
Middle Name:
Last Name:OWODUNNI
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 1:6105 N MAJOR DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-4215
Mailing Address - Country:US
Mailing Address - Phone:346-446-9787
Mailing Address - Fax:
Practice Address - Street 1:100 S LHS DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-8600
Practice Address - Country:US
Practice Address - Phone:409-751-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-26
Last Update Date:2025-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist