Provider Demographics
NPI:1083382493
Name:FOLORUNSO, OLUWATOYIN
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:
Last Name:FOLORUNSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3105
Mailing Address - Country:US
Mailing Address - Phone:443-388-9245
Mailing Address - Fax:443-388-9254
Practice Address - Street 1:1525 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3105
Practice Address - Country:US
Practice Address - Phone:443-388-9245
Practice Address - Fax:443-388-9254
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist