Healthcare Provider Details

I. General information

NPI: 1275447625
Provider Name (Legal Business Name): ABIOLA OLAOLU OMIDINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 N 9TH AVE
PENSACOLA FL
32504-7348
US

IV. Provider business mailing address

29645 JIMS CT
WINCHESTER CA
92596-6089
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0710
  • Fax:
Mailing address:
  • Phone: 909-215-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: