Provider Demographics
NPI:1023567013
Name:DARAMOLA, ADENIYI NATHAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ADENIYI
Middle Name:NATHAN
Last Name:DARAMOLA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 DAWN WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4258
Mailing Address - Country:US
Mailing Address - Phone:909-829-6386
Mailing Address - Fax:
Practice Address - Street 1:7060 DAWN WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4258
Practice Address - Country:US
Practice Address - Phone:909-829-6386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-02
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist