Healthcare Provider Details

I. General information

NPI: 1205726643
Provider Name (Legal Business Name): FUNMILAYO AMOSU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 ALL SAINTS RD STE M
LAUREL MD
20723-1750
US

IV. Provider business mailing address

9763 NORTHERN LAKES LN
LAUREL MD
20723-5893
US

V. Phone/Fax

Practice location:
  • Phone: 240-280-7020
  • Fax:
Mailing address:
  • Phone: 240-360-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18103
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3016
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number17283
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: