Basic Information
| Provider Information | |||||||||
| NPI: | 1790121861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAGOKE | ||||||||
| FirstName: | OLUWAGBOLAHAN | ||||||||
| MiddleName: | OLADIPO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12636 DARLENEN ST | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207741702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406019670 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 45482 MIRAMAR WAY | ||||||||
| Address2: | WALMART | ||||||||
| City: | CALIFORNIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017370611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 17418 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.