Provider Demographics
NPI:1346832664
Name:BAMGBADE, OLUFEYIKEMI
Entity Type:Individual
Prefix:
First Name:OLUFEYIKEMI
Middle Name:
Last Name:BAMGBADE
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 1:13180 RIPON PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6141
Mailing Address - Country:US
Mailing Address - Phone:321-961-6563
Mailing Address - Fax:
Practice Address - Street 1:3130 QUEENS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3665
Practice Address - Country:US
Practice Address - Phone:301-864-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist