MEDICARE: MRS. OMOTUNDE OYEWUNMI SOLARU B.PHARM

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	RPH020245	GA

General Provider Information

NPI Number	:	1518292465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OMOTUNDE OYEWUNMI SOLARU B.PHARM

Provider Business Mailing Address
First Line	:	6049 HITT LAKE TRL
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-6526
Country	:	US
Telephone Number	:	404-819-3110
Fax Number	:	188-860-0010

Provider Business Practice Location Address
First Line	:	6049 HITT LAKE TRL
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-6526
Country	:	US
Telephone Number	:	404-819-3110
Fax Number	:	188-860-0010

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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