Provider Demographics
NPI:1275631624
Name:OMOTAYO, FOLAYEMI JANE (RPH)
Entity Type:Individual
Prefix:
First Name:FOLAYEMI
Middle Name:JANE
Last Name:OMOTAYO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 ROYAL ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4085
Mailing Address - Country:US
Mailing Address - Phone:850-906-9471
Mailing Address - Fax:
Practice Address - Street 1:111 S MAGNOLIA DR
Practice Address - Street 2:SUITE 39
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2973
Practice Address - Country:US
Practice Address - Phone:850-656-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist