Healthcare Provider Details

I. General information

NPI: 1801615612
Provider Name (Legal Business Name): TEMIDAYO T OGUNDANA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S MEMORIAL DR
NEW CASTLE IN
47362-4948
US

IV. Provider business mailing address

24600 DALE AVE
EASTPOINTE MI
48021-1095
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-9209
  • Fax:
Mailing address:
  • Phone: 313-663-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031066A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: