Provider Demographics
NPI:1215257654
Name:SADIPE-IDONIJE, EUNICE BOLAJI (RPH)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:BOLAJI
Last Name:SADIPE-IDONIJE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:EUNICE
Other - Middle Name:BOLAJI
Other - Last Name:SADIPE-IDONIJE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3646 CANYON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2779
Mailing Address - Country:US
Mailing Address - Phone:214-213-6881
Mailing Address - Fax:
Practice Address - Street 1:2000 N PLANO RD STE 113
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4402
Practice Address - Country:US
Practice Address - Phone:214-792-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist