Healthcare Provider Details

I. General information

NPI: 1740553528
Provider Name (Legal Business Name): JELILAT OKANLAWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 RITCHIE HWY
SEVERNA PARK MD
21146-2911
US

IV. Provider business mailing address

1620 BLUESTONE ST APT M
HANOVER MD
21076-1951
US

V. Phone/Fax

Practice location:
  • Phone: 410-544-1291
  • Fax: 410-544-1529
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19795
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: