Provider Demographics
NPI:1427820836
Name:YESUFU, FUNMILAYO
Entity type:Individual
Prefix:
First Name:FUNMILAYO
Middle Name:
Last Name:YESUFU
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 1:109 NEW CAMELLIA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7829
Mailing Address - Country:US
Mailing Address - Phone:985-792-3521
Mailing Address - Fax:
Practice Address - Street 1:1100 W PINE ST
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3700
Practice Address - Country:US
Practice Address - Phone:985-386-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist