Provider Demographics
NPI:1144068776
Name:AYANDOKUN, OLUBUNMI AYANBOLA
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:AYANBOLA
Last Name:AYANDOKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 N 33RD DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6118
Mailing Address - Country:US
Mailing Address - Phone:517-489-8529
Mailing Address - Fax:
Practice Address - Street 1:8101 N 33RD DR UNIT 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6118
Practice Address - Country:US
Practice Address - Phone:517-489-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23515183500000X
AZS027037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist