Provider Demographics
NPI:1740599737
Name:OLADOKUN, BUKOLA
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:
Last Name:OLADOKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BUKOLA
Other - Middle Name:
Other - Last Name:BAKARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 W MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1906
Mailing Address - Country:US
Mailing Address - Phone:401-499-7730
Mailing Address - Fax:
Practice Address - Street 1:335 W MORGAN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1906
Practice Address - Country:US
Practice Address - Phone:401-499-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHL03493183500000X
CT0011977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist