Provider Demographics
NPI:1003119660
Name:FAKUNLE, SHERIFAT
Entity Type:Individual
Prefix:DR
First Name:SHERIFAT
Middle Name:
Last Name:FAKUNLE
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 1:13318 ROYDEN CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1218
Mailing Address - Country:US
Mailing Address - Phone:410-531-2598
Mailing Address - Fax:410-531-2598
Practice Address - Street 1:13318 ROYDEN CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1218
Practice Address - Country:US
Practice Address - Phone:410-531-2598
Practice Address - Fax:410-531-2598
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08476183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist