Provider Demographics
NPI:1669916805
Name:OSOSANWO, ADESOLA REBECCA (PHARMD)
Entity type:Individual
Prefix:
First Name:ADESOLA
Middle Name:REBECCA
Last Name:OSOSANWO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WOODBINE ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2952
Mailing Address - Country:US
Mailing Address - Phone:401-347-8881
Mailing Address - Fax:
Practice Address - Street 1:1093 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2124
Practice Address - Country:US
Practice Address - Phone:860-774-0490
Practice Address - Fax:860-774-0483
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist