Healthcare Provider Details

I. General information

NPI: 1669759908
Provider Name (Legal Business Name): GANIAT OLUWAMAYOWA OJEABULU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 ROCKS POINT PL
RIVIERA BEACH FL
33407-1103
US

IV. Provider business mailing address

4001 ROCKS POINT PL
RIVIERA BEACH FL
33407-1103
US

V. Phone/Fax

Practice location:
  • Phone: 786-877-9297
  • Fax:
Mailing address:
  • Phone: 786-877-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberSP40758
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: