Provider Demographics
NPI:1205157898
Name:AIYETIWA, TOLULOPE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TOLULOPE
Middle Name:
Last Name:AIYETIWA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 PALM RIVER RD
Mailing Address - Street 2:105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4476
Mailing Address - Country:US
Mailing Address - Phone:813-637-2600
Mailing Address - Fax:
Practice Address - Street 1:9220 PALM RIVER RD
Practice Address - Street 2:105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4476
Practice Address - Country:US
Practice Address - Phone:813-637-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63749183500000X
FLPS444281835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist