Provider Demographics
NPI:1619614351
Name:FADIPE, OLUWATOYIN GENEVIEVE (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:GENEVIEVE
Last Name:FADIPE
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 DUNWOODY GABLES DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6949
Mailing Address - Country:US
Mailing Address - Phone:240-302-5402
Mailing Address - Fax:
Practice Address - Street 1:1874 PIEDMONT AVE NE STE 100A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4816
Practice Address - Country:US
Practice Address - Phone:404-733-6800
Practice Address - Fax:404-733-6880
Is Sole Proprietor?:No
Enumeration Date:2022-05-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHI-022147183700000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183700000XPharmacy Service ProvidersPharmacy Technician