Provider Demographics
NPI:1346074911
Name:IDOWU, OLADUNNI
Entity type:Individual
Prefix:
First Name:OLADUNNI
Middle Name:
Last Name:IDOWU
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 1:11 NEWCOMB ST APT A
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2589
Mailing Address - Country:US
Mailing Address - Phone:401-440-4197
Mailing Address - Fax:
Practice Address - Street 1:1587 BRAYTON POINT RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-2337
Practice Address - Country:US
Practice Address - Phone:508-673-9691
Practice Address - Fax:508-324-4107
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist