Provider Demographics
NPI:1598497448
Name:OLORUNSOLA, MODUPE OLUWASEUN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MODUPE
Middle Name:OLUWASEUN
Last Name:OLORUNSOLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MODUPE
Other - Middle Name:OLUWASEUN
Other - Last Name:KUSORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3513 CAMBRIDGE CT UNIT 201
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-7949
Mailing Address - Country:US
Mailing Address - Phone:240-342-0315
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist