Healthcare Provider Details

I. General information

NPI: 1558755074
Provider Name (Legal Business Name): OLUWASEYI MAKANJUOLA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 RICHMOND AVE
STATEN ISLAND NY
10314-3903
US

IV. Provider business mailing address

27 DIXON AVE
STATEN ISLAND NY
10302-1938
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-0500
  • Fax:
Mailing address:
  • Phone: 718-496-8849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: