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NPI Code Detail

MEDICARE: MR. KOLAWOLE A DUROJAIYE BSC

MEDICARE: MR. KOLAWOLE A DUROJAIYE BSC
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
1183500000XPharmacist051033951IL

General Provider Information

NPI Number : 1316384217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KOLAWOLE A DUROJAIYE BSC
Provider Business Mailing Address
First Line : 2601 W JEROME ST
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1407
Country : US
Telephone Number : 773-743-5593
Fax Number :
Provider Business Practice Location Address
First Line : 3752 W 16TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-2028
Country : US
Telephone Number : 773-521-0060
Fax Number : 773-521-8770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2013
Last Update Date : 05/31/2013

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