Healthcare Provider Details

I. General information

NPI: 1912824830
Provider Name (Legal Business Name): OMOBOLANLE TAYIBAT AFINNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 IVY HILLS RD
BELLE PLAINE MN
56011-5125
US

IV. Provider business mailing address

945 IVY HILLS RD
BELLE PLAINE MN
56011-5125
US

V. Phone/Fax

Practice location:
  • Phone: 612-919-6529
  • Fax:
Mailing address:
  • Phone: 612-919-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127355
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: