Provider Demographics
NPI:1245513589
Name:AKINBOLA, IBIRONKE O (BPHARM)
Entity type:Individual
Prefix:MRS
First Name:IBIRONKE
Middle Name:O
Last Name:AKINBOLA
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 WASHTENAW RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1744
Mailing Address - Country:US
Mailing Address - Phone:734-485-3899
Mailing Address - Fax:734-485-7122
Practice Address - Street 1:2170 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1744
Practice Address - Country:US
Practice Address - Phone:734-485-3899
Practice Address - Fax:734-485-7122
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2909441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist