Provider Demographics
NPI:1477274017
Name:JAIYEOLA, BODUNRIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BODUNRIN
Middle Name:
Last Name:JAIYEOLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E 164TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2116
Mailing Address - Country:US
Mailing Address - Phone:708-527-2047
Mailing Address - Fax:
Practice Address - Street 1:17117 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3307
Practice Address - Country:US
Practice Address - Phone:708-532-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist