Provider Demographics
NPI:1013299494
Name:OKUBANJO, IBUKUNOLUWA OLUWAKOREDE (PHARMD)
Entity Type:Individual
Prefix:
First Name:IBUKUNOLUWA
Middle Name:OLUWAKOREDE
Last Name:OKUBANJO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2231
Mailing Address - Country:US
Mailing Address - Phone:908-267-2469
Mailing Address - Fax:
Practice Address - Street 1:152 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2231
Practice Address - Country:US
Practice Address - Phone:908-267-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R103305400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist