Healthcare Provider Details

I. General information

NPI: 1821318080
Provider Name (Legal Business Name): OLUWATOYIN M OGUNDIJO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 LIBERTY HEIGHTS AVE
BALTIMORE MD
21215-7119
US

IV. Provider business mailing address

11501 MYER RD
BOWIE MD
20721-2528
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-5151
  • Fax: 410-367-2718
Mailing address:
  • Phone: 240-463-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13082
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH3014
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: