Provider Demographics
NPI:1083200703
Name:TONADE, AYOOLUWA STEPHANIE
Entity Type:Individual
Prefix:
First Name:AYOOLUWA
Middle Name:STEPHANIE
Last Name:TONADE
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 1:4616 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1218
Mailing Address - Country:US
Mailing Address - Phone:215-329-4840
Mailing Address - Fax:215-225-7318
Practice Address - Street 1:3260 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5008
Practice Address - Country:US
Practice Address - Phone:215-225-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist