Provider Demographics
NPI:1457927089
Name:OYENEYIN, OMOSOLA
Entity Type:Individual
Prefix:
First Name:OMOSOLA
Middle Name:
Last Name:OYENEYIN
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 1:37300 DEQUINDRE RD STE 122
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3595
Mailing Address - Country:US
Mailing Address - Phone:586-698-2264
Mailing Address - Fax:586-698-2143
Practice Address - Street 1:37300 DEQUINDRE RD STE 122
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3595
Practice Address - Country:US
Practice Address - Phone:586-698-2264
Practice Address - Fax:586-698-2143
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist