Provider Demographics
NPI:1992081376
Name:OKEGBENR-JIMOH, BOLANLE BASIRAT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BOLANLE
Middle Name:BASIRAT
Last Name:OKEGBENR-JIMOH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 HYDE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3046
Mailing Address - Country:US
Mailing Address - Phone:786-202-8099
Mailing Address - Fax:
Practice Address - Street 1:3965 HYDE PARK CIR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3046
Practice Address - Country:US
Practice Address - Phone:786-202-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS453411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist