Healthcare Provider Details

I. General information

NPI: 1003535683
Provider Name (Legal Business Name): ADERINOLA OMONIYI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

47 CROMWELL HILL RD
MONROE NY
10950-1227
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6179
  • Fax:
Mailing address:
  • Phone: 347-338-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: