Healthcare Provider Details

I. General information

NPI: 1396619979
Provider Name (Legal Business Name): EMMANUEL OGUNSOLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S HOWARD AVE
TAMPA FL
33606-2412
US

IV. Provider business mailing address

611 S HOWARD AVE
TAMPA FL
33606-2412
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-9911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: