Provider Demographics
NPI:1366635039
Name:AWOSIKA, TAIWO KOLA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAIWO
Middle Name:KOLA
Last Name:AWOSIKA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:TAIWO
Other - Middle Name:
Other - Last Name:AWOSIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1132 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-3755
Mailing Address - Country:US
Mailing Address - Phone:219-902-7766
Mailing Address - Fax:
Practice Address - Street 1:1132 CLAY ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-3755
Practice Address - Country:US
Practice Address - Phone:219-902-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022587A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist