Provider Demographics
NPI:1922413947
Name:OLANIYI, FUNMILAYO MODUPEOLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FUNMILAYO
Middle Name:MODUPEOLA
Last Name:OLANIYI
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 1:4828 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5214
Mailing Address - Country:US
Mailing Address - Phone:337-477-9068
Mailing Address - Fax:337-477-4864
Practice Address - Street 1:4828 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5214
Practice Address - Country:US
Practice Address - Phone:337-477-9068
Practice Address - Fax:337-477-4864
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.020378183500000X
IL051292054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist