MEDICARE: ADEDAMOLA E ARIYO

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	PS34580	FL

General Provider Information

NPI Number	:	1578136321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEDAMOLA E ARIYO

Provider Business Mailing Address
First Line	:	620 S LAKE ST STE 4
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-6059
Country	:	US
Telephone Number	:	352-460-4030
Fax Number	:	352-460-4137

Provider Business Practice Location Address
First Line	:	620 S LAKE ST STE 4
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-6059
Country	:	US
Telephone Number	:	352-460-4030
Fax Number	:	352-460-4137

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

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	07/20/2021

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Directions to “ ADEDAMOLA E ARIYO ” Practice Location

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