1366840316 NPI number — DR. ABIMBOLA OLALEKAN OGUNSEMOWO PHARMD

Table of content: DR. ABIMBOLA OLALEKAN OGUNSEMOWO PHARMD (NPI 1366840316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366840316 NPI number — DR. ABIMBOLA OLALEKAN OGUNSEMOWO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGUNSEMOWO
Provider First Name:
ABIMBOLA
Provider Middle Name:
OLALEKAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366840316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 REDDEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-512-9368
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 WASHINGTON AVE STE 26
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-778-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  A10004686 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 22987 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)