Healthcare Provider Details

I. General information

NPI: 1285149054
Provider Name (Legal Business Name): OLUWABUNMI JOSEPH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2017
Last Update Date: 12/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 EL PASEO RD
LAS CRUCES NM
88001-6000
US

IV. Provider business mailing address

240 DESERT PASS ST APT 1208
EL PASO TX
79912-3624
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-1264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8843
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: