Healthcare Provider Details

I. General information

NPI: 1245479096
Provider Name (Legal Business Name): YETUNDE MORENIKEJI OBAYOMI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 BRUCKNER BLVD
BRONX NY
10473-2500
US

IV. Provider business mailing address

627 E 141ST ST APT 1B
BRONX NY
10454-2333
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-4428
  • Fax:
Mailing address:
  • Phone: 646-314-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: