=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104611185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BASIRAT OLAIDE GBEMIKAIYE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18145 CHARLOTTE DR
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60438-2272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-409-3502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18145 CHARLOTTE DR
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60438-2272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835C0205X
-----------------------------------------------------
Taxonomy Name | Critical Care Pharmacist
-----------------------------------------------------
License Number | 7151096
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 308010022
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051291884
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------