Healthcare Provider Details

I. General information

NPI: 1134895428
Provider Name (Legal Business Name): OLOLADE ABIMBOLA OLORUNTOBA-WAYAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH ST NW
WASHINGTON DC
20001-3717
US

IV. Provider business mailing address

7105 KURTH LN
LANHAM MD
20706-2169
US

V. Phone/Fax

Practice location:
  • Phone: 202-789-5345
  • Fax:
Mailing address:
  • Phone: 908-737-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100004063
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: