Provider Demographics
NPI:1073350443
Name:FOWOWE, OLAYINKA
Entity type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:
Last Name:FOWOWE
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 1:1301 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-2305
Mailing Address - Country:US
Mailing Address - Phone:804-737-6493
Mailing Address - Fax:
Practice Address - Street 1:1301 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-2305
Practice Address - Country:US
Practice Address - Phone:804-737-6493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist