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General NPI Number Information
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NPI Number | 1851668974
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Entity Type | Individual
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Provider Name | BUSOLA OYEBIMPE OGUNDIPE
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Gender | Female
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 8001 BROADWAY STE 202
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5546
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Country | US
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Telephone | 219-736-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 WILLIAM DR
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City | VALPARAISO
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State | IN
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Zip | 46385-8182
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Country | US
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Telephone | 219-707-5615
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Fax | 219-707-5619
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 26021081A
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License Number State | IN
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