Provider Demographics
NPI:1386893246
Name:POPOOLA, OLUYEMISI A
Entity type:Individual
Prefix:MRS
First Name:OLUYEMISI
Middle Name:A
Last Name:POPOOLA
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 1:104 LION ST STE B
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5071
Mailing Address - Country:US
Mailing Address - Phone:972-274-9010
Mailing Address - Fax:972-274-9086
Practice Address - Street 1:104 LION ST STE B
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5071
Practice Address - Country:US
Practice Address - Phone:972-274-9010
Practice Address - Fax:972-274-9086
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0106068332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies