Provider Demographics
NPI:1134730351
Name:GARRETT, OMOGBEMILE AUGUSTINA (PHARMD, BCGP)
Entity type:Individual
Prefix:DR
First Name:OMOGBEMILE
Middle Name:AUGUSTINA
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:O. AUGUSTINA
Other - Middle Name:
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, BCGP
Mailing Address - Street 1:9 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1738
Mailing Address - Country:US
Mailing Address - Phone:972-261-4118
Mailing Address - Fax:
Practice Address - Street 1:9 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1738
Practice Address - Country:US
Practice Address - Phone:972-261-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2336191835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric