Healthcare Provider Details

I. General information

NPI: 1215669882
Provider Name (Legal Business Name): OLUWAFOLAKEMI SUSAN OGUNDERU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 E PULASKI HWY
ELKTON MD
21921-6029
US

IV. Provider business mailing address

728 E PULASKI HWY
ELKTON MD
21921-6029
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-9595
  • Fax:
Mailing address:
  • Phone: 410-398-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27067
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: