Provider Demographics
NPI:1457673097
Name:OMOWANILE, DAVID OLUSEGUN (PHARM D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:OLUSEGUN
Last Name:OMOWANILE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CROWN ST
Mailing Address - Street 2:APT A8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2153
Mailing Address - Country:US
Mailing Address - Phone:718-962-5632
Mailing Address - Fax:
Practice Address - Street 1:296 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2812
Practice Address - Country:US
Practice Address - Phone:718-399-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist