Provider Demographics
NPI:1598362196
Name:OBIDIRAN, GABRIEL TEMITOPE (PHAMD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:TEMITOPE
Last Name:OBIDIRAN
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LIBERTY PL APT 11
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2769
Mailing Address - Country:US
Mailing Address - Phone:443-653-2520
Mailing Address - Fax:
Practice Address - Street 1:9920 KEY WEST AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3455
Practice Address - Country:US
Practice Address - Phone:301-251-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist