Provider Demographics
NPI:1194423442
Name:IKUOMOLA, GLORIA (PHARMD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:IKUOMOLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:FAMOYEGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:271 PERENNIAL DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11145 BRYTON TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7215
Practice Address - Country:US
Practice Address - Phone:704-977-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist