Provider Demographics
NPI:1861236523
Name:EGUNYOMI, ENIOLA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:ENIOLA
Middle Name:
Last Name:EGUNYOMI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 SOLIDAGO DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5560
Mailing Address - Country:US
Mailing Address - Phone:317-869-2308
Mailing Address - Fax:
Practice Address - Street 1:1102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-9404
Practice Address - Country:US
Practice Address - Phone:317-839-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030712A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist