Provider Demographics
NPI:1720337090
Name:AKINRIMISI, MOYOSORE O
Entity Type:Individual
Prefix:
First Name:MOYOSORE
Middle Name:O
Last Name:AKINRIMISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HIGHWAY 274
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6045
Mailing Address - Country:US
Mailing Address - Phone:803-831-2605
Mailing Address - Fax:803-831-9717
Practice Address - Street 1:158 HIGHWAY 274
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-6045
Practice Address - Country:US
Practice Address - Phone:803-831-2605
Practice Address - Fax:803-831-9717
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12520183500000X
NC18683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist