Healthcare Provider Details

I. General information

NPI: 1063792513
Provider Name (Legal Business Name): OLUWA TOYIN FABIYI PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 05/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W THUNDERBIRD RD
PHOENIX AZ
85023-6308
US

IV. Provider business mailing address

1855 W THUNDERBIRD RD
PHOENIX AZ
85023-6308
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-6862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056085
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS020998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: