Provider Demographics
NPI:1851643688
Name:ELEGBEDE, OYETOLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:OYETOLA
Middle Name:
Last Name:ELEGBEDE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 CHALCEDONY TER
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3496
Mailing Address - Country:US
Mailing Address - Phone:510-400-7941
Mailing Address - Fax:
Practice Address - Street 1:1023 CHALCEDONY TER
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3496
Practice Address - Country:US
Practice Address - Phone:510-400-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59433183500000X
MA25589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist