Provider Demographics
NPI:1124419213
Name:OLABIYI, MAKANJUOLA
Entity Type:Individual
Prefix:
First Name:MAKANJUOLA
Middle Name:
Last Name:OLABIYI
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 1:3214 SAPPHIRE STAR DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1263
Mailing Address - Country:US
Mailing Address - Phone:646-492-2405
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3695
Practice Address - Country:US
Practice Address - Phone:847-588-7170
Practice Address - Fax:847-588-7060
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist