Provider Demographics
NPI:1184410813
Name:OLAWOORE, OSAMUDIAME MAGDALENE (PHAMD)
Entity type:Individual
Prefix:
First Name:OSAMUDIAME
Middle Name:MAGDALENE
Last Name:OLAWOORE
Suffix:
Gender:
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 GOLDEN GATE LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1457
Mailing Address - Country:US
Mailing Address - Phone:847-477-1396
Mailing Address - Fax:
Practice Address - Street 1:1640 S GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9611
Practice Address - Country:US
Practice Address - Phone:815-288-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist