Provider Demographics
NPI:1851045975
Name:PEFOK, OMOLOLA FOLASADE
Entity Type:Individual
Prefix:
First Name:OMOLOLA
Middle Name:FOLASADE
Last Name:PEFOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13319 LANDSDALES HOPE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6381
Mailing Address - Country:US
Mailing Address - Phone:301-455-1844
Mailing Address - Fax:
Practice Address - Street 1:3400 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2021
Practice Address - Country:US
Practice Address - Phone:410-360-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist