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1184685885 NPI number — ROTIMI OMOTUNDE BOLATIWA PHARM.D

NPI Number: 1184685885
Health Care Provider/Practitioner: ROTIMI OMOTUNDE BOLATIWA PHARM.D

Information about “1184685885” NPI (ROTIMI OMOTUNDE BOLATIWA PHARM.D) exists in 1184685885 in HTML format HTML  |  1184685885 in plain Text format TXT  |  1184685885 in PDF (Portable Document Format) PDF  |  1184685885 in an XML format XML  formats.

NPI Number : 1184685885 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184685885",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOLATIWA",
    "FirstName": "ROTIMI",
    "MiddleName": "OMOTUNDE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARM.D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4418 PALMETTO INLT W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32277-1123",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-762-1794",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2080 CHILD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32214-5005",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-542-7406",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/31/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PS34979",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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