Provider Demographics
NPI:1154643674
Name:DANMOLA, ABIOLA DESOLA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ABIOLA
Middle Name:DESOLA
Last Name:DANMOLA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ABIOLA
Other - Middle Name:D
Other - Last Name:BABALOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:25404 CRAFT AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2731
Mailing Address - Country:US
Mailing Address - Phone:203-512-1617
Mailing Address - Fax:
Practice Address - Street 1:308 BROADWAY
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3007
Practice Address - Country:US
Practice Address - Phone:516-827-5814
Practice Address - Fax:516-827-4023
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053067-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist