MEDICARE: DR. OLALEKAN ABIFARIN 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	28RI03079300	NJ
2	183500000X	Pharmacist	RP441366	PA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	A1-0004116	DE

General Provider Information

NPI Number	:	1487870507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLALEKAN ABIFARIN PHARM D

Provider Business Mailing Address
First Line	:	1226 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:	267-713-7066
Fax Number	:	215-921-2708

Provider Business Practice Location Address
First Line	:	1226 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:	267-713-7066
Fax Number	:	215-921-2708

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	10/13/2015

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