Provider Demographics
NPI:1578136321
Name:ARIYO, ADEDAMOLA E
Entity Type:Individual
Prefix:
First Name:ADEDAMOLA
Middle Name:E
Last Name:ARIYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S LAKE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6059
Mailing Address - Country:US
Mailing Address - Phone:352-460-4030
Mailing Address - Fax:352-460-4137
Practice Address - Street 1:620 S LAKE ST STE 4
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6059
Practice Address - Country:US
Practice Address - Phone:352-460-4030
Practice Address - Fax:352-460-4137
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty