Provider Demographics
NPI:1275937906
Name:IDOWU, OYESUMBO OLUWAFUNKE
Entity Type:Individual
Prefix:MRS
First Name:OYESUMBO
Middle Name:OLUWAFUNKE
Last Name:IDOWU
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 1:26916 TERRI DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4821
Mailing Address - Country:US
Mailing Address - Phone:661-373-8239
Mailing Address - Fax:
Practice Address - Street 1:25450 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1704
Practice Address - Country:US
Practice Address - Phone:661-253-2357
Practice Address - Fax:661-253-4247
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist