Provider Demographics
NPI:1811580772
Name:MOMODU, LAWRENCE OLATUNBOSUN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:OLATUNBOSUN
Last Name:MOMODU
Suffix:
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 1:2880 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2565
Mailing Address - Country:US
Mailing Address - Phone:443-418-5327
Mailing Address - Fax:
Practice Address - Street 1:2880 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2565
Practice Address - Country:US
Practice Address - Phone:410-988-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist