Provider Demographics
NPI:1336469352
Name:FABUSIWA, OLUBUKOLA (BUKI) ADENIKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLUBUKOLA (BUKI)
Middle Name:ADENIKE
Last Name:FABUSIWA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BUKI
Other - Middle Name:
Other - Last Name:FAMILOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:300 E RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5014
Mailing Address - Country:US
Mailing Address - Phone:847-873-9122
Mailing Address - Fax:
Practice Address - Street 1:300 E RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5014
Practice Address - Country:US
Practice Address - Phone:847-873-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist