Provider Demographics
NPI:1528240652
Name:ADESANYA, OYEKUNBI O (BPHARM)
Entity type:Individual
Prefix:
First Name:OYEKUNBI
Middle Name:O
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4523
Mailing Address - Country:US
Mailing Address - Phone:347-837-6051
Mailing Address - Fax:
Practice Address - Street 1:1575 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-6245
Practice Address - Country:US
Practice Address - Phone:347-837-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist