Provider Demographics
NPI:1073896007
Name:FATUKASI, OLUTOYIN
Entity Type:Individual
Prefix:
First Name:OLUTOYIN
Middle Name:
Last Name:FATUKASI
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 1:7077 ARUNDEL MILLS CIR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1387
Mailing Address - Country:US
Mailing Address - Phone:410-379-3102
Mailing Address - Fax:410-379-3121
Practice Address - Street 1:7077 ARUNDEL MILLS CIR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1387
Practice Address - Country:US
Practice Address - Phone:410-379-3102
Practice Address - Fax:410-379-3121
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist