Provider Demographics
NPI:1447856208
Name:FUJAMADE, NATHANIEL OLAKUNLE (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:OLAKUNLE
Last Name:FUJAMADE
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JUSTICE RD NW UNIT 211
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6272
Mailing Address - Country:US
Mailing Address - Phone:330-906-0028
Mailing Address - Fax:
Practice Address - Street 1:24760 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:218-679-0189
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist