Provider Demographics
NPI:1588712343
Name:OLAGBENDE, YETUNDE RONKE
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:RONKE
Last Name:OLAGBENDE
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 1:105 BRAXTON WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6233
Mailing Address - Country:US
Mailing Address - Phone:678-362-3701
Mailing Address - Fax:678-581-2356
Practice Address - Street 1:550 FRANKLIN RD SE STE C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7740
Practice Address - Country:US
Practice Address - Phone:678-581-1223
Practice Address - Fax:678-581-2356
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0020102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist