Provider Demographics
NPI:1164705398
Name:IYANOYE, FOLASADE A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FOLASADE
Middle Name:A
Last Name:IYANOYE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SADE
Other - Middle Name:
Other - Last Name:IYANOYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:791 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2404
Mailing Address - Country:US
Mailing Address - Phone:305-652-7332
Mailing Address - Fax:305-652-6316
Practice Address - Street 1:791 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2404
Practice Address - Country:US
Practice Address - Phone:305-652-7332
Practice Address - Fax:305-652-6316
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPS41914183500000X
FLPS419141835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist