Basic Information
| Provider Information | |||||||||
| NPI: | 1356980668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSIBAJO | ||||||||
| FirstName: | OLUBUNMI | ||||||||
| MiddleName: | OMOTAYO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM. D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1806 LASALLE PL # B | ||||||||
| Address2: | |||||||||
| City: | SEVERN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211441603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403830001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8155 ELLIOTT RD | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108190507 | ||||||||
| FaxNumber: | 4108190847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2020 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 23847 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.