Active NPI
Bodunrin Jaiyeola, PHARMD
- Pharmacist
- Tinley Park, IL
National Provider Identifier
1477274017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 71315
- Practice address
- 17117 Harlem Ave
Tinley Park, IL 60477-3307 - Phone
- (708) 532-7477
- NPI assigned
- Sep 12, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 71315 | TX | Primary |
Addresses
Primary practice location
17117 Harlem Ave
Tinley Park, IL 60477-3307
Mailing address
19 E 164TH St
South Holland, IL 60473-2116
Phone (708) 527-2047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71315 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662940800000",
"number": "1477274017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 E 164TH ST",
"city": "SOUTH HOLLAND",
"state": "IL",
"postal_code": "604732116",
"telephone_number": "708-527-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17117 HARLEM AVE",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604773307",
"telephone_number": "708-532-7477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAIYEOLA",
"first_name": "BODUNRIN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-12",
"last_updated": "2022-09-12",
"certification_date": "2022-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "71315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tinley Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.