Healthcare Provider Details

I. General information

NPI: 1922329440
Provider Name (Legal Business Name): ENIOLA O LEYIMU PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 CAMP FRANCIS JOHNSON RD
ORANGE PARK FL
32065-5808
US

IV. Provider business mailing address

864 CAMP FRANCIS JOHNSON RD
ORANGE PARK FL
32065-5808
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-7531
  • Fax:
Mailing address:
  • Phone: 904-276-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPU4479
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS23710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: