Provider Demographics
NPI:1356980668
Name:OSIBAJO, OLUBUNMI OMOTAYO (PHARM D)
Entity type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:OMOTAYO
Last Name:OSIBAJO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 LASALLE PL # B
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1603
Mailing Address - Country:US
Mailing Address - Phone:240-383-0001
Mailing Address - Fax:
Practice Address - Street 1:8155 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7131
Practice Address - Country:US
Practice Address - Phone:410-819-0507
Practice Address - Fax:410-819-0847
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist