Provider Demographics
NPI:1922621077
Name:OSENI, MUYIBAT BOLATITO
Entity Type:Individual
Prefix:
First Name:MUYIBAT
Middle Name:BOLATITO
Last Name:OSENI
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 1:9801 PRESWICKE PT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8682
Mailing Address - Country:US
Mailing Address - Phone:770-866-1855
Mailing Address - Fax:
Practice Address - Street 1:896 HIGHWAY 81 E
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2914
Practice Address - Country:US
Practice Address - Phone:770-914-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA030744OtherPHARMACIST LICENSE NUMBER