Provider Demographics
NPI:1942525019
Name:AYENI, ISAAC AYODEJI (RPH)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:AYODEJI
Last Name:AYENI
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 1:18901 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3358
Mailing Address - Country:US
Mailing Address - Phone:718-341-0170
Mailing Address - Fax:718-341-2333
Practice Address - Street 1:18901 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3358
Practice Address - Country:US
Practice Address - Phone:718-341-0170
Practice Address - Fax:718-341-2333
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist