Provider Demographics
NPI:1740338169
Name:RUNSEWE, OLUSOLA OLUBANKE (DDS REGISTERED PHARM)
Entity type:Individual
Prefix:DR
First Name:OLUSOLA
Middle Name:OLUBANKE
Last Name:RUNSEWE
Suffix:
Gender:F
Credentials:DDS REGISTERED PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LAGRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2410
Mailing Address - Country:US
Mailing Address - Phone:845-462-2727
Mailing Address - Fax:845-462-2644
Practice Address - Street 1:35 LAGRANGE AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2410
Practice Address - Country:US
Practice Address - Phone:845-462-2727
Practice Address - Fax:845-462-2644
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049194122300000X
NY049589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist