Provider Demographics
NPI:1396231437
Name:AKINSANYA, ADESAYO OLAWALE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ADESAYO
Middle Name:OLAWALE
Last Name:AKINSANYA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3621
Mailing Address - Country:US
Mailing Address - Phone:516-668-2425
Mailing Address - Fax:
Practice Address - Street 1:2608 ROUTE 112
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2578
Practice Address - Country:US
Practice Address - Phone:631-475-4476
Practice Address - Fax:631-475-4288
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-01
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0640863336L0003X
NYI064086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy