Provider Demographics
NPI:1386993871
Name:FASEEMO, OLUWASEYI
Entity type:Individual
Prefix:MRS
First Name:OLUWASEYI
Middle Name:
Last Name:FASEEMO
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 1:314 ELTON HILLS DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2476
Mailing Address - Country:US
Mailing Address - Phone:313-721-5859
Mailing Address - Fax:
Practice Address - Street 1:314 ELTON HILLS DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2476
Practice Address - Country:US
Practice Address - Phone:313-721-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1193551835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN265686OtherPHARMACY LICENSE