Provider Demographics
NPI:1487942090
Name:ALO, ADENIYI A (PHARMD, MPH, PHC)
Entity type:Individual
Prefix:DR
First Name:ADENIYI
Middle Name:A
Last Name:ALO
Suffix:
Gender:M
Credentials:PHARMD, MPH, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3553
Mailing Address - Country:US
Mailing Address - Phone:575-887-4259
Mailing Address - Fax:575-885-8022
Practice Address - Street 1:2430 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3553
Practice Address - Country:US
Practice Address - Phone:575-887-4259
Practice Address - Fax:575-885-8022
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015938183500000X
NMRP00007193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist