Provider Demographics
NPI:1699940916
Name:OGUNBUNMI, BOSEDE OLUSOLA (RPH)
Entity type:Individual
Prefix:MRS
First Name:BOSEDE
Middle Name:OLUSOLA
Last Name:OGUNBUNMI
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 1:701 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4404
Mailing Address - Country:US
Mailing Address - Phone:718-599-1172
Mailing Address - Fax:718-599-3073
Practice Address - Street 1:701 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4404
Practice Address - Country:US
Practice Address - Phone:718-599-1172
Practice Address - Fax:718-599-3073
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist