Provider Demographics
NPI:1568034254
Name:FADIPE, OLUWATOMI BOLANLE
Entity Type:Individual
Prefix:MRS
First Name:OLUWATOMI
Middle Name:BOLANLE
Last Name:FADIPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WHISKEY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-6214
Mailing Address - Country:US
Mailing Address - Phone:405-385-4150
Mailing Address - Fax:
Practice Address - Street 1:101 WHISKEY CREEK CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-6214
Practice Address - Country:US
Practice Address - Phone:405-385-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist