Healthcare Provider Details

I. General information

NPI: 1861097487
Provider Name (Legal Business Name): JESSICA OGUNLEYE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W VERDUGO AVE
BURBANK CA
91506-2150
US

IV. Provider business mailing address

3183 WILSHIRE BLVD # 196F12
LOS ANGELES CA
90010-1211
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-9332
  • Fax:
Mailing address:
  • Phone: 916-968-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: