Provider Demographics
NPI:1013686484
Name:FASINA, IFEDOLAPO M O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IFEDOLAPO
Middle Name:M O
Last Name:FASINA
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 1:123 SUNNYBROOK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3867
Mailing Address - Country:US
Mailing Address - Phone:919-326-3395
Mailing Address - Fax:919-326-3396
Practice Address - Street 1:123 SUNNYBROOK RD STE 150
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3867
Practice Address - Country:US
Practice Address - Phone:919-326-3395
Practice Address - Fax:919-326-3396
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist