Provider Demographics
NPI:1609277698
Name:AWOSIKA, ABIOLA BALOGUN (RPH)
Entity Type:Individual
Prefix:
First Name:ABIOLA
Middle Name:BALOGUN
Last Name:AWOSIKA
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 1:1141 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1438
Mailing Address - Country:US
Mailing Address - Phone:410-282-7500
Mailing Address - Fax:410-282-7503
Practice Address - Street 1:1141 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1438
Practice Address - Country:US
Practice Address - Phone:410-282-7500
Practice Address - Fax:410-282-7503
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16109183500000X
GARPH014388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist