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General NPI Number Information
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NPI Number | 1821110461
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Entity Type | Individual
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Provider Name | OMOBOLA TAIWO RPH
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15394 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011
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Country | US
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Telephone | 636-394-6622
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Fax | 636-394-9222
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Provider Business Mailing Address
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Address Line | 2480 TOWN & COUNTRY LANE
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City | TOWN & COUNTRY
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State | MO
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Zip | 63131
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Country | US
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Telephone | 314-809-3183
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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 | 2001003742
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License Number State | MO
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