Provider Demographics
NPI:1528546249
Name:OGUNSAN, CLARA OLAITAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:OLAITAN
Last Name:OGUNSAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:OLAITAN
Other - Middle Name:CLARA
Other - Last Name:OGUNSAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6215 STONEWICK DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8758
Mailing Address - Country:US
Mailing Address - Phone:904-699-1352
Mailing Address - Fax:
Practice Address - Street 1:6215 STONEWICK DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-8758
Practice Address - Country:US
Practice Address - Phone:904-699-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44012183500000X
NC27957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist