Provider Demographics
NPI:1992138523
Name:ABIMBOLA, OLATUNJI OGUNWOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OLATUNJI
Middle Name:OGUNWOLE
Last Name:ABIMBOLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 RAY LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4226
Mailing Address - Country:US
Mailing Address - Phone:301-974-1511
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE BLDG 9
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-9098
Practice Address - Country:US
Practice Address - Phone:301-974-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212486183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Yes183500000XPharmacy Service ProvidersPharmacist