Healthcare Provider Details

I. General information

NPI: 1598907776
Provider Name (Legal Business Name): OROBOLA TITILAYO OGUNDAIRO R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 02/04/2022
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 JUNCTION BLVD
REGO PARK NY
11374-2771
US

IV. Provider business mailing address

6135 JUNCTION BLVD
REGO PARK NY
11374-2771
US

V. Phone/Fax

Practice location:
  • Phone: 718-760-6479
  • Fax:
Mailing address:
  • Phone: 718-760-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03346700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI054729-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: