Healthcare Provider Details

I. General information

NPI: 1952214140
Provider Name (Legal Business Name): AYOMIDE FOLUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6999 JACKRABBIT LN
BELGRADE MT
59714-8961
US

IV. Provider business mailing address

6999 JACKRABBIT LN
BELGRADE MT
59714-8961
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-1696
  • Fax:
Mailing address:
  • Phone: 406-388-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-117458
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: