Provider Demographics
NPI:1093184632
Name:AKINLEYIMU, TOSIN MERCY
Entity Type:Individual
Prefix:
First Name:TOSIN
Middle Name:MERCY
Last Name:AKINLEYIMU
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 1:7648 WINDBRIDGE DR APT 186
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4966
Mailing Address - Country:US
Mailing Address - Phone:214-405-6468
Mailing Address - Fax:
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:916-726-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist