Provider Demographics
NPI:1013414689
Name:AMUWO, OLAJUMOKE
Entity Type:Individual
Prefix:DR
First Name:OLAJUMOKE
Middle Name:
Last Name:AMUWO
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 1:2300 GARRISON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2309
Mailing Address - Country:US
Mailing Address - Phone:410-233-7000
Mailing Address - Fax:410-233-7000
Practice Address - Street 1:2300 GARRISON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2309
Practice Address - Country:US
Practice Address - Phone:410-233-7000
Practice Address - Fax:410-233-7002
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23905333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy