Healthcare Provider Details

I. General information

NPI: 1104229715
Provider Name (Legal Business Name): ADEOYE OWOLEWA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2014
Last Update Date: 09/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 GEORGIA AVE NW
WASHINGTON DC
20011-2927
US

IV. Provider business mailing address

5600 GEORGIA AVE NW
WASHINGTON DC
20011-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-5251
  • Fax: 202-722-4731
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100001772
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: