Provider Demographics
NPI:1881008118
Name:EKUNDAYO, OLABODE
Entity Type:Individual
Prefix:DR
First Name:OLABODE
Middle Name:
Last Name:EKUNDAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 WOOD BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1644
Mailing Address - Country:US
Mailing Address - Phone:240-620-3717
Mailing Address - Fax:
Practice Address - Street 1:21800 N SHANGRI LA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1568
Practice Address - Country:US
Practice Address - Phone:301-862-2134
Practice Address - Fax:301-862-9057
Is Sole Proprietor?:No
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist