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NPI Code Detail

MEDICARE: MRS. OROBOLA TITILAYO OGUNDAIRO R.PH

MEDICARE: MRS. OROBOLA TITILAYO OGUNDAIRO R.PH
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
1183500000XPharmacist28RI03346700NJ
2183500000XPharmacistI054729-1NY

General Provider Information

NPI Number : 1598907776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. OROBOLA TITILAYO OGUNDAIRO R.PH
Provider Business Mailing Address
First Line : 6135 JUNCTION BLVD
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2771
Country : US
Telephone Number : 718-760-6479
Fax Number :
Provider Business Practice Location Address
First Line : 6135 JUNCTION BLVD
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2771
Country : US
Telephone Number : 718-760-6479
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 02/04/2022

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