Healthcare Provider Details

I. General information

NPI: 1043627110
Provider Name (Legal Business Name): DR. OLOLADE OGUNJOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GLOBAL FORUM BLVD APT 732
ATLANTA GA
30340-4400
US

IV. Provider business mailing address

2300 GLOBAL FORUM BLVD APT 732
ATLANTA GA
30340-4400
US

V. Phone/Fax

Practice location:
  • Phone: 850-339-8937
  • Fax:
Mailing address:
  • Phone: 850-339-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026162
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52842
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: