Healthcare Provider Details

I. General information

NPI: 1982518205
Provider Name (Legal Business Name): OMOTOLA ADEBISI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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

1260 W DEVON AVE
CHICAGO IL
60660-1430
US

IV. Provider business mailing address

7200 N CLAREMONT AVE APT 403
CHICAGO IL
60645-1882
US

V. Phone/Fax

Practice location:
  • Phone: 773-751-8540
  • Fax:
Mailing address:
  • Phone: 773-751-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051309663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: