Healthcare Provider Details

I. General information

NPI: 1699343160
Provider Name (Legal Business Name): OLADIPO KOIKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HIGHLAND CORPORATE DR
CUMBERLAND RI
02864-8703
US

IV. Provider business mailing address

217 BELVEDERE DR
CRANSTON RI
02920-3603
US

V. Phone/Fax

Practice location:
  • Phone: 888-694-7287
  • Fax:
Mailing address:
  • Phone: 347-409-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH05714
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: