Provider Demographics
NPI:1861642878
Name:MAYOWA, BOLAYIBO A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BOLAYIBO
Middle Name:A
Last Name:MAYOWA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17069 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-7403
Mailing Address - Country:US
Mailing Address - Phone:302-398-4420
Mailing Address - Fax:
Practice Address - Street 1:17069 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-7403
Practice Address - Country:US
Practice Address - Phone:302-398-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10003719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist