Provider Demographics
NPI:1942073010
Name:AKINWEKOMI, OLUSOLA ISAIAH
Entity Type:Individual
Prefix:MR
First Name:OLUSOLA
Middle Name:ISAIAH
Last Name:AKINWEKOMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 FORTNER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-0069
Mailing Address - Country:US
Mailing Address - Phone:240-543-0966
Mailing Address - Fax:
Practice Address - Street 1:7990 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7790
Practice Address - Country:US
Practice Address - Phone:317-272-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024761A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist