MEDICARE: OLABISI C OBINWANNE PHARM D

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	12448	SC
2	183500000X	Pharmacist	119017	MN

General Provider Information

NPI Number	:	1295032423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLABISI C OBINWANNE PHARM D

Provider Business Mailing Address
First Line	:	151 FERNWOOD DR APT 161F
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-2249
Country	:	US
Telephone Number	:	612-702-9071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-587-9486
Fax Number	:	864-587-9504

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

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	02/24/2011

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