Provider Demographics
NPI:1992897235
Name:OLA, ADEBISI ADEWUNMI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADEBISI
Middle Name:ADEWUNMI
Last Name:OLA
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 1:14524 CAMBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3726
Mailing Address - Country:US
Mailing Address - Phone:240-481-4818
Mailing Address - Fax:
Practice Address - Street 1:14524 CAMBRIDGE CIR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3726
Practice Address - Country:US
Practice Address - Phone:240-481-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111269Medicare ID - Type UnspecifiedPHARMACIST IMMUNIZATION