Provider Demographics
NPI:1184400699
Name:OLUYIDE, OLUWATOSIN OPEYEMI (BPHARM)
Entity type:Individual
Prefix:
First Name:OLUWATOSIN
Middle Name:OPEYEMI
Last Name:OLUYIDE
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 INDUSTRY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9373
Mailing Address - Country:US
Mailing Address - Phone:209-257-0786
Mailing Address - Fax:
Practice Address - Street 1:12110 INDUSTRY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9373
Practice Address - Country:US
Practice Address - Phone:209-257-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT49426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist