Provider Demographics
NPI:1952902793
Name:PHILIPS, BIMBOLA OLUYEMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BIMBOLA
Middle Name:OLUYEMI
Last Name:PHILIPS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2201
Mailing Address - Country:US
Mailing Address - Phone:301-559-8721
Mailing Address - Fax:
Practice Address - Street 1:5815 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:WEST HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2201
Practice Address - Country:US
Practice Address - Phone:301-559-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist