Provider Demographics
NPI:1902498728
Name:WILLIAMS, OLUFEMI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:OLUFEMI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:125 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1011
Mailing Address - Country:US
Mailing Address - Phone:484-347-3208
Mailing Address - Fax:
Practice Address - Street 1:125 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-1011
Practice Address - Country:US
Practice Address - Phone:484-347-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP440652OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS