Provider Demographics
NPI:1205180023
Name:AYANBIOLA, EDWARD OLUSEGUN (RPH; MBA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:OLUSEGUN
Last Name:AYANBIOLA
Suffix:
Gender:M
Credentials:RPH; MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 GREENBELT RD
Mailing Address - Street 2:SUITE E-258
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2255
Mailing Address - Country:US
Mailing Address - Phone:301-552-5052
Mailing Address - Fax:
Practice Address - Street 1:9900 GREENBELT RD
Practice Address - Street 2:SUITE E-258
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2255
Practice Address - Country:US
Practice Address - Phone:301-552-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist