MEDICARE: FUNMILAYO OSHODE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202207554	VA

General Provider Information

NPI Number	:	1174808687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FUNMILAYO OSHODE PHARMD

Provider Business Mailing Address
First Line	:	526 FORT EVANS RD
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-4097
Country	:	US
Telephone Number	:	571-209-5631
Fax Number	:	571-209-5637

Provider Business Practice Location Address
First Line	:	526 FORT EVANS RD
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-4097
Country	:	US
Telephone Number	:	571-209-5631
Fax Number	:	571-209-5637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2011
Last Update Date	:	10/15/2011

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