MEDICARE: EBUNOLUWA GBEMISOLA OLOFIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03129423	OH

General Provider Information

NPI Number	:	1619269511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBUNOLUWA GBEMISOLA OLOFIN

Provider Business Mailing Address
First Line	:	1585 MALLARD DR
Second Line	:	APT 201
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3081
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13470 CEDAR RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-2636
Country	:	US
Telephone Number	:	216-371-4643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/10/2011

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