Provider Demographics
NPI:1508988338
Name:SULE, MUYIWA JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MUYIWA
Middle Name:JOHN
Last Name:SULE
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 1:13450 ROSEMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2087
Mailing Address - Country:US
Mailing Address - Phone:248-346-4480
Mailing Address - Fax:
Practice Address - Street 1:3812 E DAVISON ST
Practice Address - Street 2:RITE AID
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1702
Practice Address - Country:US
Practice Address - Phone:313-368-0761
Practice Address - Fax:313-368-4721
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist