Provider Demographics
NPI:1104153477
Name:AKINLOLU, IRENE A
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:A
Last Name:AKINLOLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4955
Mailing Address - Country:US
Mailing Address - Phone:972-230-3748
Mailing Address - Fax:972-230-4787
Practice Address - Street 1:731 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4955
Practice Address - Country:US
Practice Address - Phone:972-230-3748
Practice Address - Fax:972-230-4787
Is Sole Proprietor?:No
Enumeration Date:2009-11-07
Last Update Date:2009-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist