=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295063519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX OLUWAMUYIWA AKINNIYI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2009
-----------------------------------------------------
Last Update Date | 11/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 MATLOCK RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-419-0569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 MATLOCK RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-419-0569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 42709
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------