Provider Demographics
NPI:1003412966
Name:OLATUNJI, OLUWABUNMI
Entity Type:Individual
Prefix:
First Name:OLUWABUNMI
Middle Name:
Last Name:OLATUNJI
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 1:8859 BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2632
Mailing Address - Country:US
Mailing Address - Phone:301-868-4055
Mailing Address - Fax:
Practice Address - Street 1:8859 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2632
Practice Address - Country:US
Practice Address - Phone:301-868-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist