Provider Demographics
NPI:1760850093
Name:SHASANYA, AKINOLA (RPH)
Entity Type:Individual
Prefix:MR
First Name:AKINOLA
Middle Name:
Last Name:SHASANYA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6037 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2417
Mailing Address - Country:US
Mailing Address - Phone:215-796-9381
Mailing Address - Fax:215-921-5247
Practice Address - Street 1:6037 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2417
Practice Address - Country:US
Practice Address - Phone:215-796-9381
Practice Address - Fax:215-921-5247
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036975R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist