Provider Demographics
NPI:1275643496
Name:AWOTUNDE, OMOTAYO S (RPH,PHARM D)
Entity Type:Individual
Prefix:DR
First Name:OMOTAYO
Middle Name:S
Last Name:AWOTUNDE
Suffix:
Gender:M
Credentials:RPH,PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 W VIRGINIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1827
Mailing Address - Country:US
Mailing Address - Phone:202-529-7001
Mailing Address - Fax:
Practice Address - Street 1:1809 W VIRGINIA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1827
Practice Address - Country:US
Practice Address - Phone:202-529-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH3193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist