Provider Demographics
NPI:1922804632
Name:AKINLOSOTU, OLUGBEMI DICKSON
Entity type:Individual
Prefix:
First Name:OLUGBEMI
Middle Name:DICKSON
Last Name:AKINLOSOTU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 24TH AVE N APT 13
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1314
Mailing Address - Country:US
Mailing Address - Phone:431-373-3070
Mailing Address - Fax:
Practice Address - Street 1:17 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1349
Practice Address - Country:US
Practice Address - Phone:320-203-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist