Provider Demographics
NPI:1316384217
Name:DUROJAIYE, KOLAWOLE A (BSC)
Entity Type:Individual
Prefix:MR
First Name:KOLAWOLE
Middle Name:A
Last Name:DUROJAIYE
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W JEROME ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1407
Mailing Address - Country:US
Mailing Address - Phone:773-743-5593
Mailing Address - Fax:
Practice Address - Street 1:3752 W 16TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2028
Practice Address - Country:US
Practice Address - Phone:773-521-0060
Practice Address - Fax:773-521-8770
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist