Provider Demographics
NPI:1811279755
Name:AWODELE, OLUSEGUN JOSHUA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:OLUSEGUN
Middle Name:JOSHUA
Last Name:AWODELE
Suffix:
Gender:M
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 1:2117 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3030
Mailing Address - Country:US
Mailing Address - Phone:203-212-3800
Mailing Address - Fax:203-212-3802
Practice Address - Street 1:2117 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3030
Practice Address - Country:US
Practice Address - Phone:203-212-3800
Practice Address - Fax:203-212-3802
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011991183500000X
CTPCT 00119911835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist