Healthcare Provider Details

I. General information

NPI: 1396231437
Provider Name (Legal Business Name): ADESAYO OLAWALE AKINSANYA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 ROUTE 112
MEDFORD NY
11763-2578
US

IV. Provider business mailing address

52 MONROE ST
FRANKLIN SQUARE NY
11010-3621
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-4476
  • Fax: 631-475-4288
Mailing address:
  • Phone: 516-668-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI064086
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number064086
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: