Provider Demographics
NPI:1790121861
Name:LAGOKE, OLUWAGBOLAHAN OLADIPO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:OLUWAGBOLAHAN
Middle Name:OLADIPO
Last Name:LAGOKE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12636 DARLENEN ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1702
Mailing Address - Country:US
Mailing Address - Phone:240-601-9670
Mailing Address - Fax:
Practice Address - Street 1:45482 MIRAMAR WAY
Practice Address - Street 2:WALMART
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619
Practice Address - Country:US
Practice Address - Phone:301-737-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist