Provider Demographics
NPI:1194184630
Name:POPOOLA, OLUTOYIN
Entity Type:Individual
Prefix:
First Name:OLUTOYIN
Middle Name:
Last Name:POPOOLA
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 1:12 CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1222
Mailing Address - Country:US
Mailing Address - Phone:845-709-4273
Mailing Address - Fax:
Practice Address - Street 1:2074 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3375
Practice Address - Country:US
Practice Address - Phone:212-222-3653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI056735-1183500000X
NJ28RI03068300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist