Provider Demographics
NPI:1366976714
Name:OSAYUWARE INC
Entity type:Organization
Organization Name:OSAYUWARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:O
Authorized Official - Last Name:OMOKHAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-363-1095
Mailing Address - Street 1:636 NOSTRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:718-363-1095
Mailing Address - Fax:718-363-3070
Practice Address - Street 1:636 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:718-363-1095
Practice Address - Fax:718-363-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0352903336C0003X
NY0229843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04831178Medicaid
2168673OtherPK