Healthcare Provider Details

I. General information

NPI: 1174283725
Provider Name (Legal Business Name): OLUWADAMILOLA OYEGBILE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FAIRLAWN AVE
LAUREL MD
20707-4807
US

IV. Provider business mailing address

1009 FAIRLAWN AVE
LAUREL MD
20707-4807
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-0046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22798
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: