Provider Demographics
NPI:1972872828
Name:OMOTOSHO, OLUWAFOLAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLUWAFOLAKE
Middle Name:
Last Name:OMOTOSHO
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 1:40132 VILLA VENECIA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1667
Mailing Address - Country:US
Mailing Address - Phone:951-506-0708
Mailing Address - Fax:
Practice Address - Street 1:2261 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4704
Practice Address - Country:US
Practice Address - Phone:951-487-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist