Provider Demographics
NPI:1518292465
Name:SOLARU, OMOTUNDE OYEWUNMI (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:OMOTUNDE
Middle Name:OYEWUNMI
Last Name:SOLARU
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 HITT LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6526
Mailing Address - Country:US
Mailing Address - Phone:404-819-3110
Mailing Address - Fax:188-860-0010
Practice Address - Street 1:6049 HITT LAKE TRL
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6526
Practice Address - Country:US
Practice Address - Phone:404-819-3110
Practice Address - Fax:188-860-0010
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist