Provider Demographics
NPI:1457674806
Name:BAKARE, OLAKUNLE
Entity Type:Individual
Prefix:
First Name:OLAKUNLE
Middle Name:
Last Name:BAKARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-8113
Mailing Address - Country:US
Mailing Address - Phone:718-485-6303
Mailing Address - Fax:718-485-6292
Practice Address - Street 1:424 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-8113
Practice Address - Country:US
Practice Address - Phone:718-485-6303
Practice Address - Fax:718-485-6292
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist