Provider Demographics
NPI:1306085717
Name:SOGBESAN, OMOLARA ABIDEMI (PHARM D)
Entity type:Individual
Prefix:DR
First Name:OMOLARA
Middle Name:ABIDEMI
Last Name:SOGBESAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 LAKEVIEW PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4400
Mailing Address - Country:US
Mailing Address - Phone:972-954-1231
Mailing Address - Fax:
Practice Address - Street 1:9400 LAKEVIEW PKWY STE 111
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4400
Practice Address - Country:US
Practice Address - Phone:972-954-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 174H00000X
NMRP00007945183500000X
PARP441326183500000X
TX51191835P2201X
TX51195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care