Provider Demographics
NPI:1902189939
Name:FAYANJUOLA, FOLUKE (RPH)
Entity Type:Individual
Prefix:MS
First Name:FOLUKE
Middle Name:
Last Name:FAYANJUOLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 ADMIRAL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2537
Mailing Address - Country:US
Mailing Address - Phone:401-331-2636
Mailing Address - Fax:401-331-3854
Practice Address - Street 1:354 ADMIRAL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2537
Practice Address - Country:US
Practice Address - Phone:401-331-2636
Practice Address - Fax:401-331-3854
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist