Healthcare Provider Details

I. General information

NPI: 1053237099
Provider Name (Legal Business Name): BUSOLA FADOJUTIMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N BELT HWY
SAINT JOSEPH MO
64506-3013
US

IV. Provider business mailing address

1300 S 11TH ST APT 453
SAINT JOSEPH MO
64503-2569
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-1353
  • Fax:
Mailing address:
  • Phone: 240-945-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026024868
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: