Provider Demographics
NPI:1386191930
Name:OLUMESE, EHINOMEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EHINOMEN
Middle Name:
Last Name:OLUMESE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 FOX ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1838
Mailing Address - Country:US
Mailing Address - Phone:215-717-1422
Mailing Address - Fax:
Practice Address - Street 1:2800 FOX ST
Practice Address - Street 2:UNIT A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1838
Practice Address - Country:US
Practice Address - Phone:215-717-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist