Provider Demographics
NPI:1811393556
Name:OGUNSANYA, ADEBAYO A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ADEBAYO
Middle Name:A
Last Name:OGUNSANYA
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 1:407 WYSTERIA DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1222
Mailing Address - Country:US
Mailing Address - Phone:708-415-4678
Mailing Address - Fax:
Practice Address - Street 1:407 WYSTERIA DR
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1222
Practice Address - Country:US
Practice Address - Phone:708-415-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist