Provider Demographics
NPI:1578098141
Name:SOWUNMI, OLUBUKOLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:SOWUNMI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-2608
Mailing Address - Country:US
Mailing Address - Phone:209-358-3304
Mailing Address - Fax:
Practice Address - Street 1:1651 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-2608
Practice Address - Country:US
Practice Address - Phone:209-358-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist