Provider Demographics
NPI:1154639102
Name:OYENUGA, SALLY T
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:T
Last Name:OYENUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32895 BLUEBIRD COURT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555
Mailing Address - Country:US
Mailing Address - Phone:510-552-7913
Mailing Address - Fax:
Practice Address - Street 1:3760 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1428
Practice Address - Country:US
Practice Address - Phone:510-894-0552
Practice Address - Fax:510-894-0713
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist