Healthcare Provider Details

I. General information

NPI: 1821698085
Provider Name (Legal Business Name): TITILAYO OLADIPUPO PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TITILAYO ADEBISI TITILAYO OLADIPUPO

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 S ASHLAND AVE
CHICAGO IL
60620-4246
US

IV. Provider business mailing address

18529 MAPLE AVE
COUNTRY CLUB HILLS IL
60478-5694
US

V. Phone/Fax

Practice location:
  • Phone: 773-420-0290
  • Fax:
Mailing address:
  • Phone: 708-407-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number05130189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: