Provider Demographics
NPI:1265641971
Name:OBISESAN, ODUNAYO ABIODUN (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:ODUNAYO
Middle Name:ABIODUN
Last Name:OBISESAN
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13465 SORGHUM CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9756
Mailing Address - Country:US
Mailing Address - Phone:301-768-4935
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:SUITE BB06
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-7415
Practice Address - Fax:202-865-7410
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist