Provider Demographics
NPI:1225633159
Name:AMAYE, OLUMAMI O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLUMAMI
Middle Name:O
Last Name:AMAYE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:OLUMAMI
Other - Middle Name:O
Other - Last Name:AMAYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1850 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4864
Mailing Address - Country:US
Mailing Address - Phone:507-625-9009
Mailing Address - Fax:
Practice Address - Street 1:1850 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4864
Practice Address - Country:US
Practice Address - Phone:507-625-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist