Provider Demographics
NPI:1407672934
Name:OLIVE TREE SPECIALTY LLC
Entity type:Organization
Organization Name:OLIVE TREE SPECIALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NDIDIAMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPAREKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:505-738-3328
Mailing Address - Street 1:1713 WELLSPRING AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5106
Mailing Address - Country:US
Mailing Address - Phone:505-738-3328
Mailing Address - Fax:
Practice Address - Street 1:1713 WELLSPRING AVE SE STE A
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5106
Practice Address - Country:US
Practice Address - Phone:505-738-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy