Provider Demographics
NPI:1326625997
Name:ONI, FUNMILOLA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:FUNMILOLA
Middle Name:
Last Name:ONI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:LOLA
Other - Middle Name:
Other - Last Name:ONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 412258
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-2258
Mailing Address - Country:US
Mailing Address - Phone:321-368-1003
Mailing Address - Fax:
Practice Address - Street 1:31100 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-7548
Practice Address - Country:US
Practice Address - Phone:352-799-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist