Provider Demographics
NPI:1609391242
Name:SANNI, OYINDAMOLA F
Entity Type:Individual
Prefix:
First Name:OYINDAMOLA
Middle Name:F
Last Name:SANNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 ARMORY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1851
Mailing Address - Country:US
Mailing Address - Phone:757-562-7415
Mailing Address - Fax:
Practice Address - Street 1:1031 ARMORY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1851
Practice Address - Country:US
Practice Address - Phone:757-562-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist