=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225665243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SADIK OWOLEWA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2020
-----------------------------------------------------
Last Update Date | 03/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2722 W 9TH ST
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19013-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-318-4036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1430 TOBIAS DR SE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20020-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP454277
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------