Provider Demographics
NPI:1821698085
Name:OLADIPUPO, TITILAYO (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:TITILAYO
Middle Name:
Last Name:OLADIPUPO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:DR
Other - First Name:TITILAYO
Other - Middle Name:
Other - Last Name:ADEBISI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TITILAYO OLADIPUPO
Mailing Address - Street 1:18529 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5694
Mailing Address - Country:US
Mailing Address - Phone:708-407-0156
Mailing Address - Fax:
Practice Address - Street 1:1640 S GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9611
Practice Address - Country:US
Practice Address - Phone:815-288-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05130189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist