Provider Demographics
NPI:1679741474
Name:TUGBIYELE, SAMUEL AKINLOLU (RPH)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:AKINLOLU
Last Name:TUGBIYELE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 UTICA AVE
Mailing Address - Street 2:LIVINGWORD PHARMACY INC.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4397
Mailing Address - Country:US
Mailing Address - Phone:347-461-9555
Mailing Address - Fax:347-461-9556
Practice Address - Street 1:957 UTICA AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4300
Practice Address - Country:US
Practice Address - Phone:347-461-9555
Practice Address - Fax:347-461-9556
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01542896Medicaid