Provider Demographics
NPI:1417356718
Name:AYORINDE, ABIMBOLA
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:
Last Name:AYORINDE
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 1:648 SCHROEDERS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2234
Mailing Address - Country:US
Mailing Address - Phone:718-935-1033
Mailing Address - Fax:718-935-1113
Practice Address - Street 1:1336 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5912
Practice Address - Country:US
Practice Address - Phone:718-935-1033
Practice Address - Fax:718-935-1113
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist