Healthcare Provider Details

I. General information

NPI: 1528546249
Provider Name (Legal Business Name): CLARA OLAITAN OGUNSAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLAITAN CLARA OGUNSAN PHARMD

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 STONEWICK DR
JAMESTOWN NC
27282-8758
US

IV. Provider business mailing address

6215 STONEWICK DR
JAMESTOWN NC
27282-8758
US

V. Phone/Fax

Practice location:
  • Phone: 904-699-1352
  • Fax:
Mailing address:
  • Phone: 904-699-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44012
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: