Healthcare Provider Details

I. General information

NPI: 1346074911
Provider Name (Legal Business Name): OLADUNNI IDOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1587 BRAYTON POINT RD
SOMERSET MA
02725-2337
US

IV. Provider business mailing address

11 NEWCOMB ST APT A
PROVIDENCE RI
02908-2589
US

V. Phone/Fax

Practice location:
  • Phone: 508-673-9691
  • Fax: 508-324-4107
Mailing address:
  • Phone: 401-440-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: