MEDICARE: OLUFUNKEJI ADERONKE SHOLEYE PHARM. D

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	1835P2201X	Ambulatory Care Pharmacist	RPH018515	GA

General Provider Information

NPI Number	:	1205616786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUFUNKEJI ADERONKE SHOLEYE PHARM. D

Provider Business Mailing Address
First Line	:	464 MONTEAGLE TRCE
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-4912
Country	:	US
Telephone Number	:	770-401-0764
Fax Number	:

Provider Business Practice Location Address
First Line	:	5095 PEACHTREE PKWY
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2524
Country	:	US
Telephone Number	:	770-209-9299
Fax Number	:

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

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/12/2023

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