Active NPI
Samuel Adebayo Ogunmolawa
- Pharmacist
- Florissant, MO
National Provider Identifier
1225633076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2002001498
- Practice address
- 696 N Highway 67 St
Florissant, MO 63031-5106 - Phone
- (314) 830-7881
- NPI assigned
- Dec 1, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2002001498 | MO | Primary |
Addresses
Primary practice location
696 N Highway 67 St
Florissant, MO 63031-5106
Mailing address
696 N Highway 67 St
Florissant, MO 63031-5106
Phone (314) 830-7881
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0934482 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002001498 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606780800000",
"number": "1225633076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "696 N HIGHWAY 67 ST",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630315106",
"telephone_number": "314-830-7881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "696 N HIGHWAY 67 ST",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630315106",
"telephone_number": "314-830-7881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OGUNMOLAWA",
"first_name": "SAMUEL",
"middle_name": "ADEBAYO",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-01",
"last_updated": "2020-12-01",
"certification_date": "2020-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2002001498",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0934482",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.