Provider Demographics
NPI:1053911438
Name:OWOLABI, OLUWAKEMI
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:
Last Name:OWOLABI
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 1:215 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-3507
Mailing Address - Country:US
Mailing Address - Phone:301-547-9400
Mailing Address - Fax:
Practice Address - Street 1:2214 N 1ST ST
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-2036
Practice Address - Country:US
Practice Address - Phone:830-876-3506
Practice Address - Fax:830-876-9523
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist