Provider Demographics
NPI:1366619124
Name:AYUBA, OLUSEGUN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:OLUSEGUN
Middle Name:
Last Name:AYUBA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11217 MADISON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3996
Mailing Address - Country:US
Mailing Address - Phone:813-205-5255
Mailing Address - Fax:
Practice Address - Street 1:2210 E HILLSBOROUGH AVE STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4450
Practice Address - Country:US
Practice Address - Phone:813-237-6900
Practice Address - Fax:813-237-8600
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist