Provider Demographics
NPI:1336533561
Name:ABIONA, OLAWEMIMO
Entity Type:Individual
Prefix:
First Name:OLAWEMIMO
Middle Name:
Last Name:ABIONA
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 1:533 BEACH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1101
Mailing Address - Country:US
Mailing Address - Phone:973-384-7309
Mailing Address - Fax:
Practice Address - Street 1:111 MARKET ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2809
Practice Address - Country:US
Practice Address - Phone:973-624-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03516300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist