Provider Demographics
NPI:1083148134
Name:BANKOLE, KEHINDE PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:PAUL
Last Name:BANKOLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2502
Mailing Address - Country:US
Mailing Address - Phone:916-726-4466
Mailing Address - Fax:916-726-4505
Practice Address - Street 1:8101 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2502
Practice Address - Country:US
Practice Address - Phone:916-726-4466
Practice Address - Fax:916-726-4505
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist