Healthcare Provider Details

I. General information

NPI: 1831404540
Provider Name (Legal Business Name): OLAKUNLE S GBADAMOSI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 VAN DUSEN RD
LAUREL MD
20707-9463
US

IV. Provider business mailing address

6513 SPRINGCREST DR
GREENBELT MD
20770-3059
US

V. Phone/Fax

Practice location:
  • Phone: 301-617-8602
  • Fax:
Mailing address:
  • Phone: 240-593-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19600
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS45143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: