Provider Demographics
NPI:1801312038
Name:COMFORTIAL HEALTH SYSTEM
Entity type:Organization
Organization Name:COMFORTIAL HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUSEYI
Authorized Official - Middle Name:BAMIDELE
Authorized Official - Last Name:ILORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-551-0448
Mailing Address - Street 1:3404 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4121
Mailing Address - Country:US
Mailing Address - Phone:410-551-0448
Mailing Address - Fax:
Practice Address - Street 1:3404 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4121
Practice Address - Country:US
Practice Address - Phone:410-551-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16660333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16660OtherMARYLAND BOARD NUMBER
PARP441526OtherPENNSYLVANIA LICENSE NUMBER