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General NPI Number Information
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NPI Number | 1619409844
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Entity Type | Individual
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Provider Name | BAMIDELE OBAITAN R.PH., CONS.PH
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Gender | Male
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 558 FENWAY PL
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City | ORLANDO
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State | FL
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Zip | 32806-4714
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Country | US
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Telephone | 727-641-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 558 FENWAY PLACE
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City | ORLANDO
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State | FL
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Zip | 32806
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Country | US
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Telephone | 727-641-6221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 38674
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 7009
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License Number State | FL
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