Provider Demographics
NPI:1043613631
Name:IFESANYA, OLUWATOYIN O (PHARMD)
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:O
Last Name:IFESANYA
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 1:8501 FORT SMALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2607
Mailing Address - Country:US
Mailing Address - Phone:410-437-1149
Mailing Address - Fax:
Practice Address - Street 1:8501 FORT SMALLWOOD RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2607
Practice Address - Country:US
Practice Address - Phone:410-437-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist