MEDICARE: DR. FOLASADE A IYANOYE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS41914	MD
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS41914	FL

General Provider Information

NPI Number	:	1164705398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FOLASADE A IYANOYE PHARMD

Provider Business Mailing Address
First Line	:	791 NE 167TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2404
Country	:	US
Telephone Number	:	305-652-7332
Fax Number	:	305-652-6316

Provider Business Practice Location Address
First Line	:	791 NE 167TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2404
Country	:	US
Telephone Number	:	305-652-7332
Fax Number	:	305-652-6316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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