Provider Demographics
NPI:1437458676
Name:OLAGUNJU, OLUYEMISI
Entity Type:Individual
Prefix:MRS
First Name:OLUYEMISI
Middle Name:
Last Name:OLAGUNJU
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 1:36 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2116
Mailing Address - Country:US
Mailing Address - Phone:401-688-5190
Mailing Address - Fax:
Practice Address - Street 1:1114 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1509
Practice Address - Country:US
Practice Address - Phone:401-722-1897
Practice Address - Fax:401-722-4817
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist