Healthcare Provider Details

I. General information

NPI: 1225665243
Provider Name (Legal Business Name): SADIK OWOLEWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 W 9TH ST
CHESTER PA
19013-2043
US

IV. Provider business mailing address

1430 TOBIAS DR SE
WASHINGTON DC
20020-2954
US

V. Phone/Fax

Practice location:
  • Phone: 857-318-4036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454277
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: