Provider Demographics
NPI:1740458009
Name:OLAYINKA, ADETAYO O (BPHARM)
Entity type:Individual
Prefix:MS
First Name:ADETAYO
Middle Name:O
Last Name:OLAYINKA
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 1:897 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-2109
Mailing Address - Country:US
Mailing Address - Phone:386-698-2666
Mailing Address - Fax:386-698-1779
Practice Address - Street 1:897 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2109
Practice Address - Country:US
Practice Address - Phone:386-698-2666
Practice Address - Fax:386-698-1779
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist