Provider Demographics
NPI:1700486578
Name:ABEGUNDE, JOSEPH OLUYIMIDE
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:OLUYIMIDE
Last Name:ABEGUNDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 WYNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6129
Mailing Address - Country:US
Mailing Address - Phone:443-983-7978
Mailing Address - Fax:
Practice Address - Street 1:3549 RUSSETT GRN E
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1810
Practice Address - Country:US
Practice Address - Phone:301-604-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist