MEDICARE: DR. BOLANLE BASIRAT OKEGBENR-JIMOH PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS45341	FL

General Provider Information

NPI Number	:	1992081376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOLANLE BASIRAT OKEGBENR-JIMOH PHARMD

Provider Business Mailing Address
First Line	:	3965 HYDE PARK CIR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3046
Country	:	US
Telephone Number	:	786-202-8099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 HYDE PARK CIR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3046
Country	:	US
Telephone Number	:	786-202-8099
Fax Number	:

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

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	10/28/2011

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