Provider Demographics
NPI:1629218672
Name:OJO, ABRAHAM FOLORUNSO
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:FOLORUNSO
Last Name:OJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6737
Mailing Address - Country:US
Mailing Address - Phone:410-664-8644
Mailing Address - Fax:410-542-6471
Practice Address - Street 1:4380 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6737
Practice Address - Country:US
Practice Address - Phone:410-664-8644
Practice Address - Fax:410-542-6471
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist