Provider Demographics
NPI:1285358028
Name:OKUSOLUBO, AYOTUNDE OLUWASEUN (RPH)
Entity type:Individual
Prefix:DR
First Name:AYOTUNDE
Middle Name:OLUWASEUN
Last Name:OKUSOLUBO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 BACKUS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4450
Mailing Address - Country:US
Mailing Address - Phone:240-355-1720
Mailing Address - Fax:
Practice Address - Street 1:6920 LAUREL BOWIE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1710
Practice Address - Country:US
Practice Address - Phone:301-262-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist