Provider Demographics
NPI:1619130382
Name:OTTUN, TAJUDEEN OLATOKUNBO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAJUDEEN
Middle Name:OLATOKUNBO
Last Name:OTTUN
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 1:3 CARRIAGE WALK CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5512
Mailing Address - Country:US
Mailing Address - Phone:850-321-3459
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CENTER DEPT OF
Practice Address - Street 2:6900 GEORGIA AVE. NW.
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18244183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist