Healthcare Provider Details

I. General information

NPI: 1225941842
Provider Name (Legal Business Name): OMOTAYO OWOYEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6743 WINDSOR MILL RD
GWYNN OAK MD
21207-4333
US

IV. Provider business mailing address

6743 WINDSOR MILL RD
GWYNN OAK MD
21207-4333
US

V. Phone/Fax

Practice location:
  • Phone: 443-985-0078
  • Fax:
Mailing address:
  • Phone: 443-985-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30704
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: