Healthcare Provider Details

I. General information

NPI: 1366840316
Provider Name (Legal Business Name): ABIMBOLA OLALEKAN OGUNSEMOWO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WASHINGTON AVE STE 26
CHESTERTOWN MD
21620-1057
US

IV. Provider business mailing address

133 REDDEN LN
MIDDLETOWN DE
19709-1708
US

V. Phone/Fax

Practice location:
  • Phone: 410-778-4000
  • Fax:
Mailing address:
  • Phone: 336-512-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA10004686
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22987
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: