Provider Demographics
NPI:1508015496
Name:ILORI, OLUSEYI BAMIDELE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:OLUSEYI
Middle Name:BAMIDELE
Last Name:ILORI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E FORT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4762
Mailing Address - Country:US
Mailing Address - Phone:410-962-5546
Mailing Address - Fax:410-962-0577
Practice Address - Street 1:903 E FORT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4762
Practice Address - Country:US
Practice Address - Phone:410-962-5546
Practice Address - Fax:410-962-0577
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist