Provider Demographics
NPI:1770658635
Name:OMILANA, ADEYEMI AKINTUNDE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ADEYEMI
Middle Name:AKINTUNDE
Last Name:OMILANA
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 1:555 E TACHEVAH DR
Mailing Address - Street 2:#1W101
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-416-0830
Mailing Address - Fax:760-416-0832
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:#1W101
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-416-0830
Practice Address - Fax:760-416-0832
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH46012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist