Healthcare Provider Details

I. General information

NPI: 1306781547
Provider Name (Legal Business Name): IFEOLUWA PRISCILLA KAWONISE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 BOSTON ST
BALTIMORE MD
21224-5750
US

IV. Provider business mailing address

3559 BOSTON ST
BALTIMORE MD
21224-5750
US

V. Phone/Fax

Practice location:
  • Phone: 410-246-8516
  • Fax:
Mailing address:
  • Phone: 410-246-8516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: