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General NPI Number Information
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NPI Number | 1326329814
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Entity Type | Individual
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Provider Name | IDAYAT ADEWUNMI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 6555 GREENE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-4051
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Country | US
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Telephone | 347-574-4754
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 GREENE ST STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19119-4040
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Country | US
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Telephone | 347-574-4754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP440061
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | RP440061
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License Number State | PA
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