Provider Demographics
NPI:1598907776
Name:OGUNDAIRO, OROBOLA TITILAYO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:OROBOLA
Middle Name:TITILAYO
Last Name:OGUNDAIRO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2771
Mailing Address - Country:US
Mailing Address - Phone:718-760-6479
Mailing Address - Fax:
Practice Address - Street 1:6135 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2771
Practice Address - Country:US
Practice Address - Phone:718-760-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03346700183500000X, 183500000X
NYI054729-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist