MEDICARE: DR. OLABODE EKUNDAYO

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	20466	MD

General Provider Information

NPI Number	:	1881008118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLABODE EKUNDAYO

Provider Business Mailing Address
First Line	:	1012 WOOD BRANCH CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1644
Country	:	US
Telephone Number	:	240-620-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	21800 N SHANGRI LA DR
Second Line	:
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-1568
Country	:	US
Telephone Number	:	301-862-2134
Fax Number	:	301-862-9057

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

Provider Enumeration Date	:	06/14/2014
Last Update Date	:	06/14/2014

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