MEDICARE: MR. OLUSEGUN AYUBA PHARMACIST

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	PS43519	FL

General Provider Information

NPI Number	:	1366619124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OLUSEGUN AYUBA PHARMACIST

Provider Business Mailing Address
First Line	:	11217 MADISON PARK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-3996
Country	:	US
Telephone Number	:	813-205-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 E HILLSBOROUGH AVE STE 4
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4450
Country	:	US
Telephone Number	:	813-237-6900
Fax Number	:	813-237-8600

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

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	08/30/2011

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