Provider Demographics
NPI:1689946196
Name:ODUKALE, OLAYORI JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLAYORI
Middle Name:
Last Name:ODUKALE
Suffix:JR
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 1:3801 LIBERTY HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-7118
Mailing Address - Country:US
Mailing Address - Phone:410-367-8100
Mailing Address - Fax:410-367-4471
Practice Address - Street 1:3801 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7118
Practice Address - Country:US
Practice Address - Phone:410-367-8100
Practice Address - Fax:410-367-4471
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist