Healthcare Provider Details

I. General information

NPI: 1699940916
Provider Name (Legal Business Name): BOSEDE OLUSOLA OGUNBUNMI R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BROADWAY
BROOKLYN NY
11206-4404
US

IV. Provider business mailing address

701 BROADWAY
BROOKLYN NY
11206-4404
US

V. Phone/Fax

Practice location:
  • Phone: 718-599-1172
  • Fax: 718-599-3073
Mailing address:
  • Phone: 718-599-1172
  • Fax: 718-599-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: