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NPI Code Detail

MEDICARE: DR. OLUSEGUN JOSHUA AWODELE PHARM. D

MEDICARE: DR. OLUSEGUN JOSHUA AWODELE 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
1183500000XPharmacistPCT.0011991CT
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPCT 0011991CT

General Provider Information

NPI Number : 1811279755
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OLUSEGUN JOSHUA AWODELE PHARM. D
Provider Business Mailing Address
First Line : 2117 BOSTON AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06610-3030
Country : US
Telephone Number : 203-212-3800
Fax Number : 203-212-3802
Provider Business Practice Location Address
First Line : 2117 BOSTON AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06610-3030
Country : US
Telephone Number : 203-212-3800
Fax Number : 203-212-3802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2011
Last Update Date : 09/16/2011

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