Healthcare Provider Details

I. General information

NPI: 1487933792
Provider Name (Legal Business Name): ABISOYE ABISOGUN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 ENVIRON WAY
CHAPEL HILL NC
27517-4418
US

IV. Provider business mailing address

2108 WINNIE PL
RALEIGH NC
27603-2775
US

V. Phone/Fax

Practice location:
  • Phone: 919-918-7595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: