Provider Demographics
NPI:1316559925
Name:OBAJULUWA, FIYIN
Entity Type:Individual
Prefix:
First Name:FIYIN
Middle Name:
Last Name:OBAJULUWA
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 1:3524 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1360
Mailing Address - Country:US
Mailing Address - Phone:309-686-1933
Mailing Address - Fax:309-686-1187
Practice Address - Street 1:3524 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1360
Practice Address - Country:US
Practice Address - Phone:309-686-1933
Practice Address - Fax:309-686-1187
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02500111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist